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APPLICATION FOR SANITATION PERMIT Permit o. --��.�`.....- (Complete in Duplicate) Date Issued _____ 4 C,--m w 2r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wi County Ordinance No. 549. AND LOCATION �l�G -4L = __ ----�'_--_---� "' - ------------------ _4 JOB ADDRESS +_ /� t III ....... 3'�Y� ' �? ^-. Phon�----------- Address -------- Owners Name----- -•----..._ ---��..'--•--- -�' '---- - --�-- - -- --- -- ------ -- - - Address---- � �"• �� ____ .'----- - { r. s1� h_ _�e *�--------------------- --------- Phone = _A ; Contractor's Name_________________________ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ . Other ❑ Number of living units: I___- Number of bedrooms _____ Number of baths I__. Lot size ---------------------- Water Supply: Public system ❑ Community system ❑ Privafe Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam % Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No .Nf New Construction:_Yes ❑ No ❑ �' `a ---~"� . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Distance from nearest well________________Distance from foundation____._________.__.MateriaL__________t------------------------------------ re Tan_... g� f""� No. of compartments-----------------------.---Size-----------------------•--------Li Liquid depth c!a acit q P p Y --Z, �r Disposal Field: Distance from nearest well_�Q__-___.Distance from foundation_______________-Distance to nearest lot line.�___Q__._.__ Number of lines---------------- n- - Length of each line---s�---- -_-�-- Width of trenlel�h�------ `` ----------_------- a ) r{ i Total length,__t- 70__Type of filter material------ of filter material______ __ -------- Seepage Pit: Distance to nearest Well______________-.-,___Distance from foundation_____•-_-_________.Distance to ne11rest lot line----------------- ❑ Number of pits----------------------Lining material----------------- -----Size: Diameter------------------------Delpth"----------------------.--------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material��,�___________-- ____________--_____. i ❑ Size: Diameter-------------------------- --- Depth--- ------------------------------------------------Liquid Capacil- ----------------------------gals. 11 Privy: Distance from nearest well-------------------------------------------------Distance from nearest builcling.__�--------------------__:.------------ ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------- '---------------•-------------------- • I Remodelingand/or repairing (describe):-----------------------------------------------------------------------------------------•---------------.------- -------------------------------------- ----------------------- ----------------------------------- 'iI' ------------------------- ------------ ------------------------------------------------- ----------•---------------------------- n------------------------ ----------------------- ---------------------- k --- ------------------------------- ---------------------------------------------------- --------- --- -------------------------------------------------------------------------- ------------------------------------------------------------------------I---------------- ---------------------------------- I --------------------------------fI hereby certify that I have prepared this application and that the work�w`il be done in accordance with San Joaquin Count ordinances, State laws, and rule and regulations of the San-Joaquin Local Health District.. I ` (Sig- } K k— --------------- .(Q- or, Contractor) ned _711 _q V ` f � _ 2_ {Title]- �.� /� � - _eta------------------------- By�------r -------------------------------------------------------- -� �� F (Plot.plan, show��si�f-lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY R APPLICATION ACCEPTED BY------ DATE------------ REVIEWEDBY--------------------------- ----------- - / � DATE---------- ----------- ------------------------------------- 11 1 BUILDING PERMIT ISSUED--------------------- ------------------------------------------------------------------------ DATE----------------------1-------------------------------------- Alterations and/or recommendations-------- ------------------ --------------------------------"--------------------•-------------------------- ------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------t------------------------------------- m --------------------- ----------- ---------------------------------------------------------------------------------------- ---o-------------------------------------- -------------------------------------------------------------------------------------------- ---------------- ------- �In---------- -------------------------- ----- --------------------- ----------------- ------------�' FINAL INSPECTION BY--------------------- Date--------------- = SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 132 Sycamore Street 8PNorth •'C•' Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M B-51 Revised W-2100