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' APPLICATION FOR SANITATION PERMIT Permit No. ____________ ____ _ (Complete in Duplicate) c Date Iss ed '_-- --1�-jr . r\ Application is hereby made to ithe 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 N . 549. � �a -- ------ / JOS ADDRESS AND LOCATION.......2--- --�--- - ------ -�.�-t-�-0.111?- -�---- --------------------- _��o�ln- ----,�r..__._ - - --------------- Owner's Name--------------------------3 e(1--s--------- "' -{ -------- --- , Phone_ i )--�-�, ' ' z"-._--------"---- Address----------------- j --QA---•-•- ��-.Cl -- ---....----------------------------• ill � � � // Contractors Name----------•--------=•--•------- --------- - ----------------. Phone_. --- --�-��-----•-�?---- Installa+ion will serve: Resideri�e Apartment House ❑ Commercial ❑ TT iler Court ❑ Motel ❑ Other ❑_ c "_ Number of baths __-.____ Lot size .__ - Number of living units: �!_____ Number of bedrooms�� """ 'i III' Water Supply: Public systemJi❑ Community system ❑ Private4 Depth to Water Table _ ft. Character of soil to a depth . 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeJ4 Hardpan ❑ Previous Application Made: Yes ❑ Noj9L, New Construction: Yes ❑ No ❑ • ! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) :Ip, arik: Distance from nearest well-----------------Distance from foundation ____._______._.__.Material______--_____._._____.__--__________.__________.� iG"�►�� No. of compartments----- --------------------Size--------------------------------Liquid depth----------------- --------Capacity.-------------- - +� lM r D' o ie d:�yl Distance f.pm nearest well__-1.S___.._Distance from foundation_-_� Distance to nearest lot line____. __._ ��' Number oft.lines---------ll-_---I-----------------Length of each line----_- --,�---............Width of trench_._.-_ _.`1�--------------------� (� Type of filter materiaL_) '�1- "-t ( ---Depth of filter.material___-______ -- "--"--Total length__-. _______________________________ Seepage Pit: Distance t nearest well-..<7 -Distanc fGr fo ndation__�.�__.._____-Distan e to nearest lot line___�_--___.._ _-- Size: Diameter---- De th__- �_"""-- Number of. i#s--- Linin materiae_ �. p ? P I-=------- 9 Cesspool: Distance from nearest"well________________Distance from foundation-------------------- material__._-------____-__._____----______ ❑ Size: Diameter----------------------------------- -Depth---------------------------------- -----------------Liquid Capacity 9 fi Privy: Distance from nearest well-------.:_---------------------------------------Distance from nearest building-:-----------.--------------------------- Distance tlo nearest lot-line-------- --------------------------- Remodeling and/or repairing) (describe)------------------------------- -----•------------------------------------------------ --------------------------------------------------•-- ------------------------------------------------------------------------ ce - -------------------------------------•--------------------------------•--------------------------------------------------------------------------------------- --------- I hereby certif that I h�'11+a prepa ed this a±pplication and that the work will be done in accordance with San Joaquin County ordinances,,$ s, !nd rru'le� and. egulatior)s of the Joaquin Local Health District. --- -- ------ Contractor) i . ----------- (Signed) ------ - ----- --------- -- -f III' jinelafion �t� iTitle4' c ----------------- - (Plot plan, showing size of lot)�location of system to wells, bu'�dings, etc., can be p ced on reverse side). ;M FOR DEPARTMENT USE ONLY ,M t APPLICATION ACCEPTED BY------------' ------- -------------------------------- DATE---------- ' REVIEWED BY---------"------------ 0--------- --------- ----- - DATE ----------------------------- ' BUILDING PERMIT ISSUED__jM------------------------------------------------------------------------------------------------ DATE--------------------11------------------•-------------------- Alterationsand/or recommendations:----------------------------------------------- --•-------•----------------•"------------------------------------------•------...----------•-----•------------- ----------------- -----*1-------------------------------- --------- ------------------------•------------------------------------------`-------------- ----- A[ ---------------------------------------------------- --------------------- ------------------- ------------ ----- ------ ---------------------------------------------------------------------------------------------- -------------------------------- ----------------ih------------------------ ----------- ---- f J 1� � i' Date_- -------- 1-- `- J -------------------------------- FINAL INSPECTION BY:- V - -;----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American' Stroet ; 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M 10-52 Revised W-21010