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V APPLICATION FOR SANITATION PERMITPermit No. 1 -3 b ,16 (Complete in Duplicate) �./ � Date Issued Thi Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..-7o_-Y------ — - Owner's Name Address � ' flr4+ _�o ------------------------------------ -------------------- Phone.------- -----------------•------- p r Contractor's Name p= 1J1e.1. ! ----- -- -��=�'-"-;--- --- ----•------------- ��---•---- Phone------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms I____ Number of baths Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.:�T Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes 0 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material --_-_-_____---___---___-----_---____---_____-_-. No. of compartments--------------------------Size--------------------------------Liquid depth------------------ Capacity-- ------- -------------------- posal field: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line_----------_.---- Number of fines-----------------------------------Length of each line------------------------------Width of trench Type of filter material------------------------Depth of filter material--------------- -_ Total length-----------------._--____- .--__-.___ Seepage Pit: Distance to nearest welt_--- _4W Distance fro oundation__ i - ___ -- _..Distance to nearest lot line_--__--- 0 Number of pits----- ---------- Lining material__�_r.�S_Size: Diameter__-_ --1 ------Depth- s6U-------------- •� Cesspool: Distance from nearest well-----------------Distance from foundation---------.-- ----- Lining material----- ------------ ❑ Size: Diameter_ Depth -- --------------------Liquid -----•----•------- Capacity--------------------••------gals.." 1 Privy: Distance from nearest well----------------------------------------------------------------------------Distance from nearest building--------------- --------------- ---------- Distance to nearest lot line._-------_-__-_-_-_ ` Remodeling and/or repairing (describe)------------------------------ -------------•------------------------------------- ---------------•--•--------------------------------------•-------- ------------------------------------------------------•---------------------------------- I hereby certify +hat I have paeppr d this application and)+hat the work will be done in accordance with San Joaquin County ordinances, State laws, and rulds and re ulations of +he San jaqui' Local He Ith District. ` ' e rc—� (Signed). -----�. ----•--- ----= �!/,1_=�--�-- --- ---�� -- -------------------- BY - r Contractor) ------------------------ -----------------------------------------(Title)-- ---------------- (Plot plan, sh4ing size of lot, location o system in relation to wells, buildings, etc., can be pl ced on reverse side). FOR DEPARTMENT USE ONLY APPLIREVIEWED BY ACCEPTED BY--__------__.__ �' ------------------------------------- ------- DATE REVIEWED BY ------------ - -�------ - -�-------- -�- � �. t - ---------------------------------- fY~- -- ----------I-------I--------- --I--- --------------------------------- DATE----------------------- BUILDING PERMIT ISSUED ----------- -------------�--------- ---------- --�-------- DATE--�----------- -- -------- - Alterations and/or recommendations-------------------- -------- -------------------------------------- --- -------- ------------------------------------------------- - - ------------------------ 61' FINAL INSPECTION BY----------------- wll�o UI- -------- Date_-.-- --l-0--- - ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100