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v APPLICATION FOR SANITATION PERMIT Permit No. ._L��-_-_-_- (Complete in Duplicate) � Date Issued -----_--__- . plica+ion 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 complian with County Ordinance No. 549. • f r JOB ADDRESS AND LOCATI N__ ( �C-------- L-11-rJe - ��p Owner's Nameip.C.lp- 1t l i-� . ---------------------------------- Phone, Address,t UA 3-,-- QP.------- -----------LAL., _.I'L (� Contractor's Name----- ----•--- E'i'� l 4-------rt------------------------••-------------------------•-•--- ---------------- Phone. -�-q--r_9,7------ Installation will serve: Residence Uj,'-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I----- Number of bedrooms .21-- Number of baths -1----- Lot size•- w ------- f-- Z3 ------------- Water Supply: Public system [}Community system ❑ Private ❑ Depth to Water Table X52?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe 2"Hardpan ❑ Previous Application Made: Yes ❑ No 9?"' ew Construction: Yes [ o ❑ 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 ppm foundation__ _ r---------Material_--- ____~"l ---------- No: of compartments--_'1/--------------Size_ '� �. - -----------------Liquid to `' Disposal field: Distance from nearest welf__KO NL)_.Distance rom foundation-_ ---_--_.___.Distance to nearest lot line---- Number of Fines-------- _ . _�_" _ ____Length of each line-_ - t- =t g �Q----------- --Width of trench:'-7�-��- --------- Type of filter mater.ial___--I-��- ---_---- Depth of filter material_-_.-r-8/�------Total length_-_.--a'� _'_________ Seepage Pit: Distance to near st well-13 ----------Distanc rom oundation_ "_._�__ Distance to nearest lot line------�----- [v Number of pits--T----------------Lining material_ �S____-Size: Diameter-_0. .....__Depth_...,z1.__J_7�------------ --- Cesspool: Distance from nearest Wel!)_._--__=_:---__Distance from-foundation----------------'_..Lining material------------------- -------------------- Size: ____.Size: Diameter..•-••••-- ------�-------------------Depth--- --------------------------------------------`._Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------4_--------------------_-Distance from nearest building-------._._-.--_-_--_._------.----_----_. ❑ Distance-to nearest lot'line Remodeling -and/or repairing (describe):.---Y--------------------------`---- ---- -------------------------•---•-------------•----------------------------------------- r ---------•---------------- ---- ----------- --- I hereb cern that I have pr are this applica+ion and that the work will be done in accordance with San Joaquin County ordinances, ate I s,and r les Are lations of the San Joaquin Local Health District. _ ------ Contractor) - -------------------------------------------- ------ By:... - ------------------------- (ri+le)- ----- ----------- (Piot plan, showing size of lot, location of system in a ation to wells, buil ngs, etc., can be paced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------ - DATE ------------------- REVIEWED BY----------------------------------------- -- --- DATI=�--------------- BUILDING PERMIT ISSUED --------------------�=----------------------------------- DATE----------- ------ ---------------------•- Alterations and/or recommendations----------------- ---- --- - -----------------------------------------•----------------------------------------- ----••- -- ----------- -----------•-------------------------------•-------•---------------------------------- ------ -- -- •--------•-------- ------••------------------•--- -------------------------------------------------------•---------------- -----------------------------------------.-----------=_-_---------------------------------------------------------•------------• ----------- ---•------•--------------------------------- ------- ---- --• " ------------ FINAL INSPECTION By - -------------------------------------------- - Date ------------- ------------------- ------------------------------ �, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100 '