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_ oe !A APPLICATION FOR SANITATION PERMIT Permit No _.. v\ (Complete in Duplicate) Date,Issued,- - _----__-•• . Application 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 OrdinangwNp. 549. /7- JOB JOB ADDRESS AND LOCATION.... -r4 ` k = --• ---------- ----- --/ Owner's Nam ---- ----------- l�a!r1�xT - t7�it�`Q....... _ � } r� 1 Phone___._ Address ----- -------•-= ---- Contractor's Name---------------_----------- -- � - ------ ------ -------- --------- ------ ------- -------- ------------- ----- Phone- ----------- --------------- Installation will serve: Residence Rj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ h. Number of living units: -1.... Number of bedrooms .l____ Number of baths J_ Lot size -_LA-0-_ __.-_- Water Supply: Public system ❑ Community system J Private ❑ Depth to Water Table ........ ft. Character of soil to a depthof 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [ Clay❑ Adobe❑ Hardpan 1 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 st Distantfrom�ound foundation Material' `+^ .e._ ffi ► p X �_r No. of compartments __.___-. _ Liquid depth____________ ________Capacity---_�Qd Disposal Field: Distance from nearest well __v Distance from foundation Distance to nearest lot (me a Number of lines., .... _______________Length of each line--------xo...............Width of trench -,`�,._� Type of filter material------!�� _Depth of filter material. -)!;/" Total length---------41-1............._ 0 Seepage Pit: Distance to nearest well --______ ___Distance from foundation------_-----------Distance to nearest lot line-------------- F-1 ___-_______❑ Number of pits----------------------Lining material--_ ---- --- -----Size: Diameter------- ------•----.Depth- ---- -- v Cesspool- Distance from nearest well Distance from foundation Lining material--. -_-.- F1 , Size: Diameter--•- ------- ---- -- ---- -------- -- •. ....- - -----------------Liquid Capacity ---•-•--- --...•�---gals, Privy: Distance from nearest well_________ _________________________Distance from nearest building__---------------------------------------- E -__ __•._____ •--•------- --. Distanceto nearest lot line------------------------------------------------------------------------------------- ------ ------------------------------------------- Remodeling ------ ------ ----- ---------Remodeling and/or repairing (describe) ----T-------------- -- - ---- ---------------------------------I---- -------- _---- ----- ---•----- ------- ------------------------- ------ - ------- ------- ------ --- -- -- - -- -------- ------- -------- ------................................... ---•--------•------ .--•--- -•----. ----•--- --- -•----- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la , and rule ulatio of the San Joaquin Loca) Health District. (Signed) - -- ---- ---- ------- ----- -•--- --------------------. - ----(Owner and/or Contractor By:----------------—I -----------------------------------------------------........................................--- (Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ` FORAPARTtAENT USE ONLY APPLICATION ACCEPTED BY----- ....... DATE -------y_12-f-- Y---'," REVIEWEDBY. ----- ---...............................------------ ------------------------- -_............................ DATE------- -- BUILDING PERMIT ISSUED....................t................................I _t ---------- DATE.. •--• Altera --- tons and/ar re ommendat� s:____ _-- 7=.t_? _ �" �'' Wit'. --••• • ... -cj •- •....... ....... FINAL INSPECTION BY:----------------� •_ Date--- _..?_-- ------ --------- ------- ----- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Straaf 300 Wast Oak Street 132 Sycamore Street 814 NoA "C" Sfraaf Stockton 'California Lodi, California 1 44faaa, California Tracy, California ES-9-2M'8-51 Revised W-2100