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I yh APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) 0/1 71—- --: 7 �? Date Iss - Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in compliance with County Ordinance No. 549. / ATYPO p. ]HOT--Cl _ � �� i &oa/. JOB ADDRESS AND LOCA ION__&'J-_-6-0_X___201_-_7,-.{.GAJ_A '8 Owner's Name---:�a 01161 c- ._'moues-l_�? ----------•------------ Phone,�4 Y��J'�6 --------"--------------------------- i Address------------------ -------=------•- �- •C M- ------------------------------------------------ Contractor's Name-----?- , /?4n -------------------- Phone.' D__ _O 1_ �s 1 Installation will serve: 'Residence X' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ �-- Number of bedrooms _/ Number of baths _4 Lot size Water Supply: Public,system ❑` 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 ❑ Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yes 15�' No ❑ TYPE OF INSTALLATION ANDSPECIFICATIONS: I .:.� (No septic tank.or cesspool permitted if public sewer is available within 200 feet.), Se t Tank: Distance from nearest wellj,(Q��__Dista from#foundation--/6__--..Material_____ �1 No. of corn ar#ments_ '► - aci--------------- ,�, p 5ize�, � Liquid depth_ �' CapacityB Disposal Field: Distance from nearest well/d4Distanafrom foundation-----/cl_ Distance to nearest lot line------,l-KS__�"� Number of fines----�________1_ _-- Length of each line___ �-^ 11 �5j! g oi -----��-----.Wid#h of trench--- Type of filter material_j___�_-__IG�____Depth of filter mater al____ __-'_Total length_____yrl, "------------------------- { Seepage Pit: Distance to nearest wefoundation______-._--__--____.Distance to nearest lot line__,___`________ ❑ Number of pits------ ------Lining material----------------------- =------Size: Diameter----`--:•--------------Depth--------------------- Cesspool; Distance from nearest well-------_---------Distance from foundation__ __-_-_-_____' ,Lining material------- -- _❑.,,..., ,,, Size: Diameter- ---- ---------------------------3--- Depth-A ----- I--- ---Liquid Capaci - ..�,.f _ ,.� _�. ---gals. [. Privy Distance from nearest well ----- -------- - _____ ____ __-- _Distance from nearest building:' F ❑.' Distance to nearest}lot line - ,- „ :--------- - Remodeling and/or repairing (describe):____-___-__Y--------------------------------------------------- -- S ------ # ___________________________________________________________________________________________________________________________________________________________________________________ t I `' y u hat'1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate ws,"and rules and regulations of the San Joaquin Local Health District. ; �--- �. (Signed)-•-- ---1 __l'' - - "-� w i -------------------- r Contractor) •--- ------------ ----- -- (Plot plan, showing size of lot, location of system in're ion to wells, building , etc., can be placed on reverse side). l s FOR DEPARTMENT USE ONLY APPLICATION.ACCEPTED BY--- ----=--------------lf: ------- DATE-------- REVIEWEDBY---------------------------------------- -- ----- --- DATE = ------------------------------------------------------ - - ---------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE----------------- -------------------------------------------- Alterations and/or.recommendations___________________ ! -----------------• •--------------------------------- ------------------------••------------------------•-------•------------ ------ ---------------------------------------------------------------------------------------------------------------------------- ----------- 4 �__________ ______________________"____-_-___-________-__--_-______________- "._._--__________ __________________________________________________________ . i •-------- ------------------------------- --------------- FINAL-INSPECTION ----------- --•- ------------- Date r -- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfraef 814 North "C" Sheet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100