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APPLICATION FOR SANITATION PERMITPermit No. a _-'� _.. (Complete in Duplicate) Date Issued Applicafion 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.__.-_-____ -�-__---0.2- 7V,1-'- ----S�-c----- _7V�, Owner's Name----------------------- -•----- � 0 !"_C ------- C7----------- j - Phone_ -------- _Q_ __-� _r/ ' /-'- -J------_-----_----_--____ Address--------------------------------------- Contractor's - - - Name--------------- _�,.�/.r--!_-,C_,-- ----�x!/�r_/_�.1_�lA�"' -��11��-sJ �..f7�°r----_-.-- Phone --�� -- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms #____ Number of baths --- Lot size __ G.� __._ -.� r___________________ Water Supply: Public system X Community system ❑ Private ❑ Depth to Wafer Table ________ ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: YM-* No 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_J rlvJ_-Distance from four;dation-f4Q-�-----Material. ------------------------- ?A rr` Capacity ---=�# _-.-.--- - KgL - - --------- � �cNo. of compartmets --------------I -------S�ze� E� -' cf quid depth_-* � =----- CapacitYO- fr_ --- • - ._ � /Disposal Field: Distance from nearest } Distance from found _-Distance to nearest lotIN line__•-�_____..._. Number of lines___________ __________________Len fh of each line--_- ` r �� g .S Width of trent `----------------- Type of filter material__ i_._ --�aD,pth of filter material-----/ ��-------Total length___ J___`_ � ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line___.____________ ❑ Number ofpits----- ----------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------_` Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Liningsmaterial_______-_--__-_--_-_________-_______- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. . Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------- --_----- ❑ Distance to nearest ]of line--------------------------------------------- -------------------------•------------------------------------------ ------------------------ Remodelingand/or repairing (describe)------------------------------ -----------------------------------------------------------------------------------------------------•--------------- -------------------------------------------------------•-------------------------------------------------•-- ----------------------...--------------------- ----------------------------•------------------------------------ I hereby certify that I hay prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St fe I w and rule and regulations the San !oa- uin Local Health District. (Signed) 't � t -----------------------------------{�� Contractor) - - - - ----- - - - -----------------------------------------------(Title)-- y --I---G'-'r`f----------------------- {Plot lan, show- + p g size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------- ------ ------ ------ ---- DATE- ' - REVIEWEDBY------------------------------------------------------------- -------------------------------------------------------------- DATE_-------- ---------- BUILDINGPERMIT ISSUED--------------------------------------------------------------- -------------------------------------- DATE- Alteration and/or recommendaf'ons: --- -- -------- ----------------- ._ --------- - -----------�------ - C'AL �• ------------_ s ------ ----� e -' ------- - --- --- V ----------------------- -- -----------------------------------------------------------9_1---------- FINAL INSPECTION BY------------- ' / . 7 `' , __-5 _ x _.___--_____--_-- --- 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