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iE c �ur * , r 4 -.4, L r APPLICATION FOR SANITATION PERMIT Permit No. _ ________ � (Complete in Duplicate) S Date Issued 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------7.3-�---- 5-01---�� f l -�'�- ----------------------------- ------ ------------------------------------------- / s /� 1 r / Owners Name "/ /6 t- -------------------------- Phone -__ta_t _ 1- Address -26 ---- .------ r''O: .Q.l---------- /J Contractor's Name---------------------------- �_ _+- L�44 !�- 5 ' -� -5 ---------------------- Phone---'�,--,f6--PP--7-------- Instailation will serve: Residence J' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms._ Number of baths ___;ti___ Lot size __�p. __ !�_ _r________.___-.______- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Tabl"Fs ' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 04"t Hardpan Previous Application Made: Yes ❑ No ® New Construction: Yes ❑ No ❑ oa -r.�a, �j1��,✓ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material________-______-________________________...____. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line--------•---------------------Width of french----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length_--__---___-____•_______-______________-__ ' See age Pit: Distance to nearest well___NO3/]&-_____Distance from foundation_v_r____._..Distance to nearest lot line_ •-----••- '.., Number of pits-----(----------------Lining material_-& Ur---Size: Diameter-__sli_p---______Depth__Z__�__------------ .... Ue-. Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------------------.-------------- Size: Diameter------------------------------------ Dept- P -----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___________________________-_____________. ❑ Distance to nearest lotline---------------------------------------------------------------------------------------------------------------------------------------- ----- Remodeling and/or repairing (describe)---------------------------------------------------------------------------------- .......-------............••---------------------•------------------ --------------------------••------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------..------....-------------------------------•-------------------------- ------------------------------•--------------------•-------------------------------•- ••----•--••-------------------------------------------------------------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rules and reguI ins of the San Joaquin Local Health District. (Signed)---- i`!34 . -(Or Contractor} S . 0- --5� ---- Title (Plot plan, s ing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ---__- DATE�----------------------------------------------------- - ---- -------------•------------- ------- --------------------------------------- REVIEWED BY-------------------------------- _ DATE-.t----- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE --- ---------------------- ---------------------------- Alterations and/or recommendations------------------------------------ ------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------ --------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-- ----------- Date 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 8-51 Revised W-2100