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APPLICATION FOR SANITATION PERMIT Permit No. ___........... (Complete in Duplicate) ,6 Date Issued . - ::. Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei d s e . This application is made in compliance with County Ordinance No 49. �- q JOB ADDRESS A LOCATION..-- - : 1____Jr! ►_9Ut.rl__..__ tlfl�.I�'. _I4� ------------------- L — Ne--------- ------------- Owner's F I S-I-•----~----------------------------=------------------------- --------------- --------- -------_ Phone_----------------- Address..- 50 ---- ------. _..... Address.- [_ A j � �' --------------- --------- � Contractor's Name---- . 1 I .........�.Z.?. -------------- A'**696.6 � Installation will serve: Residence Apaohnsen'�-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms Z_ Number of baths --- Lot size ...... ___ 4 .'................. Water Supply: Public system ❑ Community system X Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam, Clay ❑ Adobe I' Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted- public seyrer is available within 200 feet.) cc � Septic Tank: Distance from nearest well_-450©---.Distance fr m fou dation f-p-o Material_ � - No. of compartments,:.._-___ / Size_ 3 _ _ Liquid depth___.."--------_______Capacity f�_ > i Disposal Field; Distance from nearest well`73�__-__:-Dis ance from foundation__.Ig..........Distance to nearest lot line____.__..r Number of lines....... ___ Length of each hne__..:�,�' -_d'_:Width of trench..___�,"�___'!_______ ________ r rir - Type of filter material.___ ______Depth of filter materia_._/_!-------Total length....... s --_ ________________ 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 Capacity----------------------------gals. Privy: Distance from nearest well _____ _____ __________________________ ___Distance from nearest building--------__.______________________________- ❑ Distance to nearest lot line---------------------------------- ----•--------------••--•-•--------- ----•--------•------•----------------•---------•--•- ------ Remodeling and/or repairing (describe)_______ _________ -------------------------•----_----- ---------------•----•-----------------------------•-- --•--------------------------•-----_---- •-- ---------................................................... ---------------- ------------------• ----------------------------------•-.---------------••• •--••••-•--------------•-- --------•----------------------•--------------------------••---- Y ------------------------------------ ---- ------------ -------- -------- ---•--- -------- ---------------------- -------------------------------------------------------------------------------- 1 hereby ce ' t 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules nd re tions of the San Joaquin Local Health District. (Signed)-------------- ---•---• -- ----. ....... -...................... Contractor.) By:..........................................................-------------••----------•-----•----•--•---•------ --- --------- - -- -----:J - .....(Title)-- + _-1._!?1_ ct -- (Plot plan, showing size of lot, location of system in rely i n to wells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-------------------------------- ______......................................... DATE.......... '�S _ REVIEWEDBY ------------------------------- ---- -------- ---- --------------- ----- __ DATE BUILDING PERMIT ISSUED...............................................................-...................................... DATE--------------•-------•------------•----------•--•----------- Alterationsand/or recommendations:_...............................----------------•----•-------------------•------------••-•--•------------...----------------•----------------••-----------•- ---------------•----•-••-- ................................................... =`�` -------------- ------------------------ ------ -- ------------------------- ---------- 1 mss' V• r FINAL INSPECTION BY:.... .. ------------------ --•-- --• .__9�!V� 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