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APPLICATION FOR SANITATION PERMIT Permit ` (Complete in Duplicate) //. Date Issued!�'".-.t..•�' Applical-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 Ordinance No. 549. E2�� P.wQa. . JOB ADDRESS AND LOCATIO .. 1 ? C Owner's Name ._.: r Phone...------ . ----------•-------------•- /' 23 / Address------- � ------- ----------------------------------------------- -------------•----------------------------------------- ------Q Contractor's Name........... •--------------------------------------------------------------------------•--------------------_..- ------ Phone.................................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units ------ Number of bedrooms ___umber of baths ---f--- Lot size ______.. Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table J. __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ^ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No * New Construction: Yes [><No ❑ 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---'�7PO----Distanc f om foundation----/0---------.Material ------.-D"Yt,C`. .� . No. of compartments-------- ______.__Size- 8n_ __Li Liquid de th___._._____ _______Ca aci ©� q p P Capacity-8.994P ------------- Disposal Field: Distance from nearee t well__,t2d ,_Distance from found 1- n-_ _,�'.. _.Distance to nearest lot line-._.._. Sd Length of each li �__ !-ZI..Width of trench.___.. ...._ Number of lines___._ _._ LL�__--jj __ � Type of filter material ---- epth of filter rrfa er"ia��—��______Total length_........_./-,;L --•------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_____-.--_-___-_-_---_____.____-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------- ElSize: Diameter----------------- ----------- ------Depth---------------------------------------------------,Liquid C�pacityM -------------- FIs... Privy: Distance from nearest well_________ ________ _________ _____________Distance from nearest building----------_. _._._ --------------------- t ❑ Distance to nearest lot line---------------------------------------------------------------------------- ---•------------------------.............. ------- Remodel ------ Remodeling� �pnd��/o�r in d scribe):--�)� 4-4--40--------------- ---�f o'G�G!rll� --•------ ,,►/d .. ... ��-$ ' ----- -- ?b &i� ---- ---------- ___-_-_- ---- -- ---------- ------------ --- = b 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and ions of the San Joaquin Localis Owner and/or Contractor (Signed) f ,.� ---A__, --- 1,2, ( / ) By:---------------------------------------------------------=----------------------------------------------.......------------------(Tiitle)---------------------------------------------------------------- (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 APPLICATION ACCEPTED BY--------- ----- - ------------------------------------- -- DATE ..... -- REVIEWED BY -- ---------- ----- --- ------ A DATE.. BUH-DING 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 814 North "C'Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100