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_ Q APPLICATION FOR SANITATION PERMIT Permit No. __ __5.._.... [Complete in Duplicate) D Date Issued �__4�__7_-___----- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install+he work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATIO -------R_�___1-----R-oJ1 ---------7-_'�__'�_ !�ROK -------------- Owner's Name----------- ----------------k - -- ------------------- ------- Phone---------� --- ----=----•--•----- a Address------------ ------I--- , tie. ------ (lam ----•-•------------------------- it`-- -------------- ------ Phone----------------•----••------------ Con#rector's Name.------=•_•_•--- -•-" ------------------•-------------------------------------------------------------------- - - Installation will serve: Residence Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _1___ Number of baths ---/--- Lot size _12"4_Y---6_1?------------------------- Water Supply: Public system ❑ Community system ❑ Private ja Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[5k Hardpan [ Previous Application Made: Yes ❑ No a New Construction: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.), Sufic Tank: Distance from nearest well---,3t'l ---Distance from foundation-----b ----------Mate __ _______1 91 " i uid depth----- _ ____ _- __Ca acity•-sNo, of compartments_____�{______________Size__ ___ ____ _ ~ t Dp Disposal Field: Distance from nearest well____.S_d------Distance from foundation_,___ ______Distance to nearest lot line__ Number of lines----------------I-----------------x-Length of each line-----_--_-1 ..........Width of french---.7-----------_-------------- Type of filter material_Y%__7_f��'C Depth of filter material- -___ __.��___..__Total length-------1 fi b______________________ - f" 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-------------------- g�lS. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------.----- --------.... ❑ Distance to nearest lot line___________________ __" Remodeling and/or repairing (describe) j-"--- ---------------------------------------------------------------------------• --------------------•--------------------- , ---•-----------------------•----------------------------------------------------------------------------------------------------------------------------------------------"-•----------------------------- ----------------------------------------------------------------------------------------------•------------------------------------------------------------------•--------------------------------------------------------..._ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and-rules and regulations of the San Joaquin Local Health District.. [Signed):------ -- ----------•-w -_ r_rt - ---- -- ------------[Owner and/or Contractor) By:---------------------------------------------------------------------------------------------- ------------------------------(Title)------------ --------------------------------------------------- ----------------------------------------------- - ----- (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---------V---- --- ------------------------------------------------------- DATE REVIEWED BY------------------ ------- --- ---- r - ----------- - �----- -- --------- ---------------------------------------------------------- BATE---- -------- ---------- ----------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------- ----------------------------------------------- DATE-- -------------------------------------------------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------- _____________________________________________________________________________________________________________________________________________________________________________________________________________________________ - tt ,'`` FINAL INSPECTION BY:-----W- ------------------------------------------ Date-------- .10 _ ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 8-51 Revised W-2100