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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7 Date Issued ----__/__. - 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. � ►�.� ` ,o y� ` ` JOB ADDRESS AND LOCATION- -C75' _ -.-- -- �- V .- ( h.rf_b_R_g�lt-�----- -----r r/C�� --- Owner's Name-------------- -r--_ � A � 1---- -- ------- -- Phone Address ` 0 - - ••--- "". ..... 000, ._------ fj Contractor's Name--------PL=1 --------------------------------- --- •----------. Ph ne..77_4Q._-6_'�PZ 0 Installation will serve: Residence Apartment House I-] Commercial Commercial E] Trailer Court E] Motel El Other El Number of living units: _-�__- Number of bedrooms _1.--- Number of baths _-_- Lot size __ __________ _ e ` - Water Supply: Public system Community system E] Private [-] Depth to Water Table -------- ft. lam} Character of soil to a de th of 3'feet: ISand Gravel P ❑ ❑. Sandy Loam ❑ Clay Loam Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction,_Yes E❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ` 0 (No septic tank or cesspool permitted iplic seer is available within 200 feet.) Septic nk: Distance from nearest well_'�1�""1]istance from foundation_. Chi f r n f 0----- Materia`- ---- ----- - No. of compartments-:-_ a .`._. Size_.�3_-�V-_�2__.�Liquid depth__'17S_�-__---Capacifiy_.-___._��_ Disposal Field: Qistance from nearest well-l.` istance-from oun ation--I_�.._..__._.Distance to nearest lot line--,'f [� Number of ---------- �} --__ii-- -- ____--Length of each line--- -1r1'_--- �i-----.Width of trench_. y�!!------------------ Type of filter material--- I(_--Depth of filter material-__..1cf_...--___Total length.... -Q- --__--___-___- Z Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------.------Distance to nearest lot line-_._-_--__---__-_ ❑ Number of pits.- ------Lining material-----------------------Size: Diameter---------------------- Depth--------------------------------- i9rt r Cesspool: Distance from nearest well-----------------Distance from foundation....--------------- Lining material--------------------------- ------ w ❑ Size: Diameter---=------- - ---------- -------°Depth----- ---_.------------------------------------------Li quid Capacity---------- - gals. Privy: Distance from n arest well-------------------------- --------------Distance from nearest building -Distance-to nearest lot line-_w-------------------------- ----------_-___ Remodeling and/or repairing (describe :--------- ------------------------------------------------•----------•---•-- � -----•------.•------------------ ---------- ------------•------•-- ---------••--------- ------------------------•----------------------------------------------------•------------------------------ -- -------------------••--------• ---••---------- --•--------•--------•-----------------------------------------------------------------------------------------------------------------------------I------- ------------------------------------------------------------ --------------------------------------'---------------------I--------- --------------------------- I hereby c rtiIthat I have prepared this a plication and that the work will be done in accordance with San Joaquin Count ordinances, St to ule and reguiatio s of the S n Joaquin Local Health District. 4 y . -- y 5 (Signed) ------- Contractor) By:----------------•-----=---------------------...' --- (Title) (Plat plan, showing size of lot, location of system in relatio to welts, buildings, c., can be pl cad on reverse side). i 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 3 DATE_.-' t �.— ----------------------- REVIEWED BY = --"---------------------- DATE---- --------------------------- BUILDING ATE . BUILDINGPERMIT ISSUED------------ -------------------------------------------------------------------------------------- DATE------ Alterations and/or.recammendations: ------------- ----------- ----•-•---------- •---------------------------------------- of�v------•-----••--•----------•----•----.------ -----------•----------------- I------ n - i ' -------------------------------------k- ------ ---------•--- ..._ " ----1, --- ----------••------•-------. ---- FINAL INSPECTION BY:.-------------------------------------------------------------. Date----------------• = r SAN JOAQUIN LOCAL HEALTH DISTRICT { 1 , 130 South American Street 300 Wes{ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Man{eco, California Tracy, California ES-9-21A Revised W-2100