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1 APPLICATION FOR SANITATION PERMIT Permit No __ .- -- (Complete in Duplicate) Date Issued7-c.r� �_-.---=5--:A Applica{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 compliance with County Ordinanc .No. 549. JOB ADDRESS AND LOCATIO -=-----L_---=/---.1 - --- ----- ___ . --• Owner's Name-_29--4-14-1------- `I ------ -------------------------- ---- hone------ Address------1__--�.._J-4--Z)----------- -----_ ---- 1�0� -- ---�-- '�------- ---•-- --.. ---------- ---"--------- Contractor's Name... -------- ---- --------------- ---. Phone-- -.•---1„�-.--.--V-- Z�. •- - Installation will serve: i.Residence (- Apartment House 0 Commercial [—]. Trailer Court E] Motel ❑ Other E] , S r Number of living units: Number of bedrooms .-1--- Number of baths ___/___ Lot size _____ __________________________ ' Water Supply: Public system '❑ 'Community system ❑ Privateepth to Water Table Jeff. F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 16-PLlay Loam ❑ Clay ❑ Adobe. Hardpan ❑ ` Previous Application Made: Yes ❑ No.9 New Construction: Yes 6 No - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) O' Septic Tank: Distance from nearest well-----------------Distance from foundation-------.------:____.Mater':al-------------------------------------------------- comartments_______________ r . No..of ' P ----+----.Size--•-----------------------------Liquid.depth---------------------------capacity--------------- ------- --------------- ---- ---.CapacitY-----------••-- ------- r Disposal Field: Distance from nearest well------J10 _.Distance from foundation------e�,_D_..___.Distance to nearest lot line__ I, Number of lines---------______I____ . --Length of each line_______- Width of trench___ Type of filter material---/4.________ Depth of filter material- 1_ ______ e________Total length_______ _ 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__*__---r._____ -----Depth-----------------------------------------------4-------Liuid.Ca aci.t r Privy:' Distance-from nearest well-------------------------------------------'-- Distance from nearest-building___._______________--_.__________.____._- ❑ Distance to nearest lot line__-__-'.:__-__. �. '— F. A. Remodeling..and/or repairing (describe :--------- --------------------------------------------------- •------•---•-----------------•--• -------•---•----- _ r� r ------------------------------------------------•- c-----------------------•------------------ ` ------------------------------------r---------------------------------------------------------------..--------------------------------------------------------------------•-------•----------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules.and-,regulations of the San Joaquin Local Health District, (Signed) " x'011. f -------------------------------------(for Contractor) By=------ -- ----------------------------------------------------------------------------------------(Title]....-- ----------------------- (Piot plan, showing size:of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r E FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -1---- --------------- - ------------------------ DATE--------- j REVIEWED BY--------------:------------- -- ------------ DATE---------- -------------1----------- BUILDING PERMIT ISSUED-----------------------------•--------------•---------- --------------------------------------------- DATE--------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------•-----•-----•------•----------------•-----------•- ----------------------------------------------------------•----------------------------------------------------------------------------------•-----•-......•------•-•---------------------•----------------- .... ------------------------- -------------------------•--------- ------ ------------ -----------------. ------ ---------------•------------------------------- ------------------------------------------- ----------------- FINAL INSPFCTION BY:_' Date-----------------� ----------A-------------------- ---------------------- j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street' 132 Sycamore Street 814 North "C" Street 't Stockton, California Lodi,:California Manteca, California Tracy, California ES—A---2M Revised W-2100