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APPLICATION FOR SANITATION PERMIT Permit No. .___.__ -��.-/ (Complete in Duplicate) Date Issued - ��/`� A�p!lilation is hereby made to-the San Joaquin Local Health District for a permit to construct and install the work herein described. T 's application is made in compliance with County Ordinance No. 549. ---------- --- - JOB ADDRESS AND OCA TION--- --- --- --------------1pf-V -114�...... ...... ..4-- --------------------------- F6V _. t 17 1 /-/- Owner's Name--Z--- - 7. ------------ ----------------------------r___.__ -- -------- ------------ -------- Phone.----/------------ --- -------------- ---------- ------------------------------------- -------------- Address------------- ------ -------------------------------------- ---------------- Phone---X11 ----------------------- Contractor's Name--- ---- ------------ ---- - --------- Installation will serve- Residence Apartment House E] Commercial [I Trailer Court El Motel [] Other F1 Number of living units: ---1-- Number of bedrooms -47 Number of baths ----L Lot size ----------------- ------ Water Supply: Public system El Community system El Private Depth to clay Table _. ft.Character of soil to a depth of 3 fee+: Sand [-] Gravel F1 Sandy Loam a Clay Loam El Clay E] Adobe E] Hardpan E] Previous Application Made. Yes El 'No D, New Construction: Yes E] No 0-�� TYPE OF INSTALLATION AND SPECIFICATIONS; (No septic tank or cesspool permitted if public sewer is available V41h;n 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------ 116. of compartments---------------------— Size--------------------------------Liquid depth---------------------------Capacity----------------------- ❑ Disposal Field: Distance from ;lge t 11 4' D lot line-------115' WV- -----70------ i,fance from foundation-----v��--------Distance to nearest -------- C, - --------Width of trench --- ngth of each line---------- -- ----------- - - - Number of lines - ------- ---- -------- Type of filter maferial-//�it Type ------- -----Depth of'filfer material------- ----------Total length- 9--- t I Seepage Pit: Distance to nearest well-----144� —Distance f f afion-----S".-.--.Disfanr ------------ .,e to nearest lot Ii-91 ni material_ - ......Depth____.CP --------------- Number of pits---------I------------Li ng Size: Diameter---- Cesspool: Distance from nearest well-----------------Distance from fou.nclation-------------------.1-ining material.-_._____--------__.___-.".__._ Size: Diameter--------------------------------------Dept h----------------------------------------------------Liquid Capacity---------------------• ....galA ❑ 'from nearest well__.______________________ Distance from nearest building_____.____________---.-______..____--.--. Privy: Distance ---------------------- 'Distance'fo nearest lot line-----------------7-- - I ----------------- ---------- -R--e--m---o--d--e--l-i-n--g-- and/or---r-e--p--a--i-r-i-n--g----(-d---e-s--c--r-i-b--e--)-:------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------- -------------------------------------------------- --------- --------------------- ------------------ -----------------------------------------------------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------- ---------I-------------------------------------------- --------I--------------------------------------------------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou'n?7— ordinances, Sta"Jvs. and rules and re�ulattions of +he San Joaquin Local Health District. -------------- f Contractor) (Signed)---------- ----- - ----------------— BY:------ -1--------------------------------------------------------------------------------- Title - --------- (Plot plan, showing size- .of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------------------- ---- ---- ------- -- APPLICATION ACCEPTED BY----- -- -- -- ----- DATE ------I------------ --- REVIEWEDBY----------------------------------------------------- ------------- ---------------------------------------------------- DATE ------------------------------------------------------- BUILDINGPERMIT ISSUED-------•---------------------------- ------ - --------------------------------------:- DATE-- ---------------------------------------------------------- Alterations ATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- ---------- -------------------- --------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------I------------------ ------------------------------------------------------------------------------------- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ --------------I-------------------------------------- ---------- -------------------------------- -------- ----- ---------- ---------------------------------------------------------------------------- -L- ? "',)7 --5�3 FINALINSPECTION 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 10-52 Revised W-2100