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APPLICATION FOR ISANITATION PERMIT Permit No. ._. (Complete in Duplicated Date IssuedV7�/i7� .__ Applica+ion is hereby made to the San Joaquin Local Health District for a permit to constr&t and install the work herein described. This application is made in compliance with County Ordin nce No. 549. 5L(( =,). 140 �62- , yD JOB ADDRESS AI4D LOGATIJO ;9!- -- ----------- 1 --.-./�C ' _ � - \-------- i•�'et'e._-------• -- •yy� - --- - --- ------- - he e------------- ------ '7P ---- r Owner's Name------------!!.� --- --- ----- ------- ---- ---------- --- -- --E---- --- - ..J Address '7 t[ a - --------- ------- ------ -------- ------ - - ------- ^ �..._ -.� �. Contractor's Name----�LlQ'f Phone Installation will serve: Residenc �It Apartment House E] Commercial E] Trailer Court ❑ Motel [I Other ❑ Number of living units: _-_ ___ umber of bedrooms ko- Number of baths __I___ Lot size _ _ -. ___ ----------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ACq_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobejY Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,*ank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tank istance from nearest well_________________Distance from foundation_-_---1-_________-Mater iai----------------------------------.----_---_____. o. of compartments--------------------------Size-------------------------------Liquid Edepth--- :__..... ---Capacity------------��---►►----- Disposal Field: Distance from nearest well----_ Distance from foundation 1B_'-.r______-Distance to nearest lot line__- .______ Number of lines__________-/ -�_______. Length of each line----- of trench______ _________________ Type of filter material- .� -Depth of filter material__---e-__-________Total length_______1__!_0_______________________ - W Seepage Pit: Distance to nearest`well_---________._____--Distance from foundation--------------------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---------------------------- --------Depth------------------------------------------ ------;Liquid Cap-acitY = gals. _. Privy: Distance from nearest well-----_____-----------____--_--------------------Distance from nearest building_.=,___________-_____------_-___-_______- ❑, Distance to nearest lot line--------------------------------------------------------------- -----------`---------------------------------------------------------- , ' r• • ---- ----------- '- --- --- __ Remodeling and r re ring des rib '.` .- - r ~~ -----• --------------- i -- �-- pro---------�------- ----��'�'---� _ '_�`-- - - --- --- - ---------------•--•- - - , I hereby certify that I have prepared this plication nd that the work will be done in a Wance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. .► (Signed) ----------------------------------------------------------------------------- -------------------------------------------------------(Owner and/or Contractor) B :?C � °' a •_-- .. ,�-y------e--------------------------------- ----------------{Title} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------------------------- ------a------------ ---------------------- ---------------- DATE----- ---------------------------------•------------------- REVIEWEDBY-------------------------------------------- ------------- - ---- -- --- ----- --------- --------------------------- DATE-------------------------------------I--------------------- BUILDINGPERMIT ISSUED------------- ------------------- --------- --•--- DATE-------------------------•--------------------------------- Alterations and/or recommendations: --------- - - ------ --- -jy j /! i/ ------------- �JY - FINAL�SPE TI N 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 Revised W-2100