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.` �•- � � f f v �edw ' y APPLICATION FOR SANITATION PERMIT Permit No. .4 !f + l (Complete in.Duplicate) Date Issuedg'+� 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 Ordinance No. 549. JOB ADDRESS AND (O O s } Owners Name ------it ---- - Phone..................�q� ---------- Address -------------- ------i -.-ro-_-------_--------- -------- ............ Contractor's Name ------ ------ Phone...................................--------- --------------------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ____/__ Number of baths ,_1._._ Lot size .____ _ J&-O.............................. Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table _-*"-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel❑ Sandy Loam ❑ Clay Loam ❑ Clay K Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yes K 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�p_�_-- Dista jri found ion -------•,Mater, 1_- Q�• ! . No. of compartments_:___--`Y"____-___-SySize__, _ ,?�_ Liquid de th____ '______.__Capacity_.a—&-.o..��_••____ Di posaI Field: Distance from nearest well_A_400_TDistance from foundation._/. .-.Distance to nearest lot line.-,.7t___.______ Number of lines__ '_______ Length of each line-___4tlP "_____..Width of trench �•�. '� _ ___ Total length-.'... Type of filter mater ial__�Qf" dDepth of filter material_._.___ -_ Seepage Pit: Distance to nearest well ______.--------------Distance from foundation....................Distance to nearest lot ❑ Number of pits______________________Lining material-----------------------SizeDiameter-------_---- ----------Depth Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material-_ _____---------------------- F1 __:_._-.._:_______❑ Size: Diameter-----------------------------------.- Depth------------------------------------------------I_.__Liquid_Capacity ---------------------gals. Priv -Distance from nearest well________ _ - _ =---Distance from nearest baildi ----------------------- ❑ Distance to nearest lot line-------- --------- ----- - -------------- ----- -•••--..._.. •--- -------------------------------------- Remodeling - -------- --- -__ -----Remodeling and/or repairing (describe)---------------------------------------------------•--•---•--•------------•-•--............ •-- .......................................... -------------------------------•-------•----•--------------•-----------•----------------------------------•-------------------------------------•---------•----•-•--------•---•-------------•--------------••-------_------ 1 hereby certify that I have prepared this application and that the work will be done in-accordance wifh San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------- ' ------ -- - ---------------- --------- ----- ---- --- ----- --- --(Owner and/or Contractor) �1 -- Vi -- ------- ----------------------------------- ---- Title ------ .. __Y ( )(Plot plan, s `mg size,of lot, loem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT'USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------ -------------------------------------------- DATE..................... ....... REVIEWEDBY------------------------------------------------------------------- DATE- .._�_ . .41.....................................BUILDING PERMIT ISSUED------_------ --------•--•--•-•------•- .--------------••--•. DATE• ••__�_ Alterations and/or recommendations--------------------------------- -------....................................... ----- ----- ----•-•----••------ - FINAL INSPECTION BY----------------- ---• -- Date------- a-C. ___ 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