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e J �� ' APPLICATION FOR SANITATION PERMIT Permit No. _.` .u... Duplicate) i l Com ete n r y� �•v p 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. 49, JOB ADDRESS ND LOCATION-----� ---/------- --- =1-------�4y_,---------------------------------------I----------------- Owner's Name__ d?-x-----•- e --------- ------------------------------ ----------------------------------------- Phone_--3----tZ-A--7------- Address..----- ------Address..----- -------•- S ------ ------•--------- ----- --------------------------------------------•------------------------------- --------------------------- Contractor's Name----Y ! �- dp----_ , ---------------------------------------------------------- Phone_-I-- _ R-2------ Installation will serve: Residence $( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 'Number of living units: __A---- Number of bedrooms -L Number of baths ---/___ Lot size -------------------------- Water Supply: Public system g Community system '❑ Private ❑ Depth to Water Table A? ft. Character of soil'to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobebt Hardpan ❑ �� Previous Application Made: Yes ❑ No V New Construction: Yes ❑ No `- .` 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--------------------------CaaciFY------------- -�----- r D•ssposal Field_ -Distance from nearest wellel`14P#*�_ _Distance from foundation-----/ `�_--__Distance to nearest lot lin`e:__�+---------- f Number of lines-------------�"----�------------Length of each line_______�Q---------------Width of trench -' k- ----------------------�� F Type of filter material---- __-_ _ _Depth of filter material------/J?�-.f-.--Total length_______ __"_______________________ Se epa e Pit: Distance,.to nearest well_- Distance from foundation____V_�_____.Dista�e to nearest lot line--- ""-_______ f Number of pits-- ------/-----------Lining material------------ __ Size: Diameter---- 3__-___- Depth____ '------------------- Cesspool Distance from nearest well-----------------Distance-from foundation--------------------Lining material-_____-__---_-__________________-__. ❑ Size: Diameter----------------:----- -- --` Depth Liquid Capacity-------- Is. ' Distance from nearest-buildin Privy: Distance from nearest!weil_ f --------------------------- 9 _-❑ Distance to nearest lot line--------------------------- ------------------------------------------------------------------------------- 4 Remodeling and/or. repairing (describe}:-- ----------------------_------------------ r- ---- ------------------------------------------- ------•-------•-----•-•----•_.j.--------•-------M......---_•-- -- -----_ ________�______________________________ _• 1.4 ---•- •-___•______________••__--___________-•_________--___-____-_______--_• I hereby certify that I have`pr'epared this application and +hat the work will be done in accordance with San Joaquin County _,'ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. +" i --------------------------------------- Qwaa.end/or Contractor] ------------- ---------- By:.. Title - --- ----------------- ----------------------------------------------------- -----( ] (Plot plan, showing size of lot,.location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR�DEPARTMENT USE ONLY APPLICATION ACCEPTED BY v ;---------c------------------------ ----- DATE-------A------ ---- . REVIEWED BY-------------------------. ----- DATE -BUILDING PERMIT ISSUED--------------------- --- '--------a------------- -------------------------------------- DATE--------C!---------------------------------------V -- Alterations and/or recomm nda+ions:__-- """"---------- ---- -- -------------------- -------------- ----- -- - /� - --------- 3 = = ----- ---- ---"-h - .`� = ----------- p a c� � if �! ; ---------- ------------- --------------- -------------- --------- ---- ----- - -------- ---- - - -------------- --- ---- FINAL INSPECTIO BY'-- ate ------------ --- ------------------------ ---- - " r SAN JOAQU 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 b _