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APPLICATION FOR SANITATION PERMIT Permit No. . .�._F__ (Complete in Duplicate) /{ Date Issued __ _j_ -_ --------- 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. r / JOB ADDRESS AND LOCATIPI�__ ---------"'----'--------A�Q-es?----- ' f 1 = Owner's Name tCtl _..__1'1��c ,ez.- Phone -"�"-= Address----------------- �'� 9 A/n--e----------- -- Contractor's Name-------------------- F}ir 1�-----S�7 �� one Ph � Installation will serve: ' Residence Apartment House ❑ Commercial ❑ Trailer':Court ❑ Motel ❑ Other ❑ Number of living units: _�____ Number of bedrooms -&-- Number of baths ___�___ Lot size ___ r-x_1.O Q-'________-___-_____ Water Supply: Public system [Z Community system ❑ Private ❑ Depth to Water Table ________ ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑- Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) LT , Septic Tank: Distance from nea;res# we;J40AC-___Distance from foundation_1-Q-_�---___.Material_"_ 4-- ------- -_---_ No. of compartments-----Z----------------Size_: '_X__Sm- Liquid depth------ _�-��------Capacity------PoD s1r% V-63'• .Bop Disposal Field: Distance from nearest well--_-------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------------ ----------- Width of trench._--------------------------------- O Type of filter material------------------------Depth of filter material----------------------Total length------------------------------ Seepage Pit: Dis#once ------------ -� to nearest well_ _pi,9______Distance from f undation_2g_i-------MIfI ce to nearest lot line._+.-__-___ ; Number of pits---- ----------------Lining mate ria l -----Size: Diameter___ca o.__--__.-_-- Depth____X47 I - - --------------- Cesspool: Distance from nearest well-------------.---Distance from foundation--------------------Lining material------------------- -------------Deh Depth--- # _Li uid Capacity ❑ . Size: Diameter-------------------- p -----=---------------------- -- - q ---------•-------- -------gals. Privy: Distance from nearest well-----------------------------------------------4 Distance from nearesr building----------------------------------- 0 Distance to nearest lot line________________ _ ' -- Remodeling and/or repairing (describe):------------------------------------- ----------------•---------•----•--------------------------•-------------------•- --------------------- ---------------_-____"---------------------------------•---------------------------------------•-----------------•-•----------------------------"----------------------------- -- - ---- ! hereby cer that I have preparapplication and that the work will be done in accordance with San Joaquin County ordinances, Stat la and rulesXjedUfThn* nssof the San Joaquin Local Health District, (Signed) ------- - ----- - --------:------------------------------------------- ----- ( " Contractor) . By_ � _ { } �e�-ti-I Y (ion 7ofsysYn ---- ------------�� - -------------- Title -!'f'1_ �/�' -------------------- (Plot plan, showing size of lot, locrlation-towells, buildings, etc., can be placed on reverse side}. "FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY os- ---------------------- l DATE — REVIEWEDBY---------------------------------------------- -------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------- Alterations and/or recommendations----------------------------------------------------•---------------- -----------------"•---•-----------------------------••--•-"----------------------------------------------------------------------- ------ ------------- -"---------------------••--------- --------------------------------------------------- ------------------------------------------------- ---------------•-------------------------------------- ----------------------------------•---------•----------•--- i ------------- FINAL INSPECTION BY------------------- - ---------- Date_ . ----f f ' -5:f ------------------------------------------ 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 10-52 Revised W-2100