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APPLICATION FOR SANITATION PERM, Permit No. ..... [Com(Complete in ?� Duplicate)p 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. 549. JOB ADDRESS AND LOCATION------ -----�� r �-�---------- ----------------------------------------------------- --------------- t� Owner's Name _ : ;�1- 1. ��----- -------------------------------- Phone Address-----------------------------------------------------t .0-4 Q---�-0-- G"�-- G Q_kE..._ _31 C'------------------------------------------------------------------------- Contractor's Name, ... f s_ "'1__I 12 i ;�n = ?__ Phone ---;OF � B Installation will serve: Residence Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel [[ OtherVO4'" Number of living units: 10___ Number of bedrooms t_Q_-- Number of baths __ Lot size _-_'________________________ Water Supply: Public system' Community system ❑ Private ❑ Depth to Water Table A_V__0ff. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No J9. New Construction: Yes ❑ No ❑ ��•�� p� ,;,, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Ta k:. Distance from nearest well________________Distance from foundation_____'__________.Material------------------------------------------------- O iu.._ No. of compartments--------------------------Size--------------------------------Liquid thL-------------------------Capacity-------------- ------- Disposal Field: Distance from near, Length well--W�u_�:Distance from foundation_____________Distance to nearest lot line __-_ Number of lines---1__---------__ Lth of each IinE--_-_ -_Q Width of trench____ � _________ g Type of filter material___ -___Depth of filter material_____ `_____Total length_______� _ -------------- .... _ Seepage Pit: Distance to nearest well---nt -__Distant fr m foundation___-----------Distance to nearest lot Number of pits-------I-------------Lining material ��' ' �i'��----Size. Diameter____.,4_r3_'--------Dept h___•P2------------------------- Cesspool: 0_`________ ____--__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______-___ ______-_-_---__--.__..___. ❑ Size: Diameter--------------------------------------Depth--------------------------------- -- -----------Liquid Capacity--------------- -------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____�______-___-_____....__-___- -_..� ❑' Distance to nearest lot line------------------------------------------------------------------------------------ ---------------------------------------------------------t" and/or repairing [describe):__. _____ f__- _ ----- -----------------------------------------------------------------------------------------------------------------------------•----------------------------------------•--------------------------------------- ------------•--------------•--------------•---•----------------------------•------------ ------•-------------------------------------------------------------------•-- --------------.....--------------------------------------------------------------------------------------------------------------------- I hereby certify that rha. a prepared this application and that the work will be done in accordance with San Joaquin County ordinances State la , and rule and regulations—of—the San Joaquin Local Health District. Signed)- - - ---4-- -------"-------------------------------------------------- . Contractor) ,. By:-- - -- -- -------C.. -'-- 49-11- _ ------------------------------------------------------------------(Title)--- Iq-tZ9J-1-------- ------- ' (Plot plan sh ing size of lot, loco+ion of system �i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---------- ------------------ ----------------- -------------------------- R---------- DATE--- ----------------------------------------------- REVIEWED - ----------------------------- REVIEWEDBY----------------------------- -- - --------- ---------------------------- --------------------- --------------- DATE--------A` ------------- ----------------- - -------------- BUILDING PERMIT ISSUED---------------------------------------------------- ------------------------------------------------ DATE------------ ------------------------- Alterationsand/or recommenda+ions:---------------------------------------------------------------------------------------------------------------------------------------------------------------- +1 -----------------------------------------------------------------------------'--------------------------------------------------------------------.----------- --------------------------------------------•-- 1 - ----------------------- ------------------ -------------•------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------- ------------------------------------------ ------------------------------ ------------------------------------------ ----------------------------------------------------------------- FINAL INSPECTION BY:/"` '______________ � Date - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+ree+ 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