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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here n described. This application is made in compliance with County Ordinance No. 549. .0 _44,Vk' V(/ ---- ------ _A_�5 A ................CIII. .... ...... JOB ADDRESS AND LOCATION e ----- --- ----- Owner's Name.___,S�n V�_ -t_ A -- -- ------------- -- ------------- ca 1,�_ ------------------------- -----------A--- - - ---- ------------------- ------ Phone____r------------------------- -------- ----------------------------- Address--_------------- -7 -0- _----I--------- --------!�--- /-------------------------------------------------------------- Contractor's Name---------df5�--------------- -----I---------------------------------------------------------------------------------------------- -----•-- Phone----------------------------------- Installation will serve: Residence 69'Apartment House [-] Commercial 0 Trailer Court El Motel E] Other ❑ Number of living units: _4---- Number of bedrooms --- Number of baths ---L Lot size ------- ------- ----------- Water Supply: Public system El Community system [] Private to Water Table�� Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam P!r�Clay Loam Ej Clay E] Adobe E] Hardpan ❑ Previous Application Made: Yes El No g? New Construction: Yes [�No E-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1I__!-'V0__Dista5p from foundafion__'!/__V-___..Materia�--- R�r No. of compartments__________ --Size... _X 1S;7Z ------------------Liquid clep�h------------!�r--------____Capacity___ __ Disposal ield: ---Capacity--- Disposal/Field: Distance from nearest w I- Distance from foundation-----/_0 r-----Distance to nearest lot line-,.1-a--- -4 Number of lines____________ Length of each line/-.--" ----- Width of trench-------- P------------------ Type of filter material-Arl------;�__ Z-—--------_-Depth of filter material-------1*__q-------Total length_______._� _________________ Seepagg'Pit: Distance to nearest well.___ "-----Distance from f9undation-----!F7�_ -------Distance to nearesf lot line-----ZA--- Number of pits---------I---------- material----kh�.!_-_-__.Size: Diameter------ --------Depth--- ----------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______._____--_____.______________ Size: D;ameter-----------------------—-----------7Depfh-----------------.....-----------•-- : :-_-----.,___Liquid Capacity----------------- r7-----gals. Privy; Distance from nearest well____________________________________________ --Distance from nearest building______._______-_---__-___________..__..._. ❑ uilding------------------------------------------ El Distance to nearest lot line------ - ----------------------------------------------------------------------------------------------------------------------------- ----- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------ --------------••-•----------------------------------- ----------------------------------------------------------------------•---- ------------_*----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------`----------------------------------------------------I------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------I--------------------------I------------------------------ I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin Co4unfy . ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------------- --------- ---- ---- ------t------------------------------------------------------------------------- -------------------------(Owner and/or Contra r By:- -------- --------------- ------------------------__(Title)------------------------------------------------ ---- n of system in relation to wells, buildings, etc., can be placed on reverse side). (Plot plan wing size if lot, loa�i?n OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ ---------------�DATE �:! t/ REVIEWED BY-----------------------------------------V . ... DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------- ---------------- 411 Alterations and/or reco rn mend afions _r1V --------)-k---Al /�ft----12_v,�..... ----------- --- - -- -------- _-_17------------------ ---- ---- - ---------- ------------ ------- ------------------------------- ------ --- ------------------------- ----------- ------- - --------------------------------_----- ------m--------J��--- ---C 7 ------ ------ --------------------------------------------------------------------------------- --------------•--•----------------------------•- - --------------------------------- FINAL INSPECTION BY:-- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lod!, California Manteca, California Tracy, California ES-9-2M . Revised W-2100