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APPLICATION FOR SANITATION PERMIT Permit No. 1/ � _4.-_____ (Complete in Duplicate) Date Issue __ ref Applica4ion 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 with Counfr O dinance No. 549. 44tVc ---JOB ADDRESS AND LO TION__ -1 -•-- --- ------------------------------------------------ Owner's Name- - f � ---- -------- ---- -- ---- -- -- -- -- - -------- --- -------------------------- -------- Phone ---•• Address------------- -' - r� ' _ - - - -- ------------ Contractor's Name----- i--- _-_�..1___ ±----- Q--�• ---- Phone-- _Q��- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living,units: __I___ Number of bedrooms _-__4Number of ba 1____ Lot size ___--Jam`-� ___/_ c� - ------------------ Wafer Supply:Supply: Public system ❑ Comf un1f9`syst '❑�"Priva'fe epth to Water Tdbl� ft. Character of soil to a depth of 3-feet: Sand ❑`'-Gravel ❑ Sandy L am ❑ Clay Loam ❑ -Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ INo ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLAT16N ANd`SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: DisAnce from nearest well________ Distance from foundation-------------------.Material------------------------------.------------.____. 17-7 i • NoAof compartments---------------------_--Size------------------------•-------Liquid depth--------------------------Capacity---------------------- .00 D�spos I,Fi Distance from nearest well_________.___.-Distance from foundation____________________Distance to nearest lot line________.___-.__. Number of lines--------------- ------------ -g_Length of each line------- --------------------.Width of trench----------------------------•------ Type of filter material.----,_1-----------,k__Depth of filter material -------------------Total length------------------------------.-_------- kin_.---_.-- k /� s ff n Seepage P Distance to nearest well w_e'll_ ___Distance from foundation___-I�........Distance to nearest lot line__/_Q_-_____ Number of pits__17Y__4(.._ .' Lining material_- ize: Diameter----- _ _-_- Depth------- Cesspool: Distance from nearest well___ n ________Distace from o dation____-------__-_-__.Lining material_-______.__________._________________ ❑ Size: Diameter--------------------- ---------------Depth--------------------- -----------------------------Liquid Capacity----------------- ---------gals. ______ ________ Distance from nearest building Privy: Distance from nearest well______________________ ____ _________ g---------------------------------------- - A ❑ Distance to nearest lot line----- ---------------------------- --------------------------- ---- --------------------------------- ----------------------------- Remodeling and/or repairing (describe)______________________� ----------------- 1-•-------- .' 1 \J r ______________________________________________________-_______________.. _______________________________________________...__-__._________________________-_________________---.____..___-______-___________.._._-__- I hereby certify that I have prepar this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul ions of An San Joaquin Loc 1 Health District. e, (Signed) d-- ---101- ----- - (O n400ntracfor) By---------------` ---- F 6 - ------ --------------------- --------------------------------------------(Title)-- ------- - --- ---------------- (Plot plan, showing sizeiof lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ------------ ------ ------ ---------------------------••-------------- DATE! ------------I------------------------------------ REVIEWEDBY --------------------------------------------------------------------------------- DATE---- BUILDINGPERMIT ISSUED------------- •----•--------------------------------------------------- •----------------------- DATE------------- - -------------------------------------- Alterations ------------------------------------- Alterations and/or recommendations:__- :7,,___ =-F. .r_ w_.w _ 1 ------ ---------------------------------------•--------------------------------------------------------•-------------- �, f FINAL INSPECTION BY:--------------------1/...... t' �3 --- Date----------- 2---tl----------------------------------------------------- SAN -S-1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100