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k � q T.. APPLICATION FOR SANITATION PERMIT`' Permit No. .` °2_. _1- -- (Complete in Duplicate) - Date Issued -r 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 Ordinance No. S49. _ JOB ADDRESS AND L CATION_-_.-_--2D S M1 -- '------------- -------------•-•-------------=---------------- -------------•-------------------------------- Owner's Name------------ - Phone-- „ -----_ -------- -------------------------- Contractor's Name--- 1 _ P �� -- ---- a11 ------- ------ Phone-2 ---%------------- Installation -- -- will serve: Residence®`partment..House ❑ ,.,Commercial ❑ Trailer Court E] Motel El Other ❑ Number of living units: /I Number of bedrooms -----_.- Number of baths hi-tot size,___---1490 y Water Supply: Public system (� Community system ❑ Private ❑ Depth to Water Table 3s ft. Character of soil to a depth of 3 feet: Sand. .Gravel Sandy Loam Clay Loam ❑ Clay ❑ Adobe [L�ardpElan Previous Application Made: Yes ❑ No NE] ❑_.. ew Construction: Yeso �' N ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted'if public sewer is available within 200 feet.) I ~.. Septic Tank: Distance from nearest welt-;�--_-___ __Distance from foundation_--- A ; No. of compartments-----sc----------------Size-� �XS --------------Liquid -- �-- -----------Capacity_C4' t Disposal/Field: Distance from nearest well_�4>�.__Distance from fou ndation-.�d-_---___--.Distance to nearest lot line-_�3.-.-__-.-_. L� Number of lines--------- ----------.---- Length of:each line_--_-Sa--'_--_ 3� - g -- - -�-----Width of trench.-- �-��--�--- ------------ - Type of filter material-.----_� _-_ _Depth of filter material_--._/_r --..Totalf length-----------�--6 Seepage it: Distance to nearest wall-/__� _--___Distance from foundation---- dDistance to nearest lot line---------- ---- [ Number of pits------- -..---- --_--Lining material- .Size: Diameter----- -8-" Depth..... . _�---------------- Cesspool: Distance from nearest well---------------- Distance from foundation- -----------------.Lining materia l--..-.------_-.-_----_-----.--_ ❑ Size: Diameter--------------- i--------------------Depth--------------------------- -Li Liquid Capacity_. q ------------------------gals. Privy: Distance from nearest well---------------- ----------------------------- --Distance from nearest buildin Distance to nearest lot line------------------------------------------- r -------------------------------------- Remodeling and/or repairing (describe): _1 a -------•------- -------•--------------------•--------------------------•------- ----------••-------•--------•---------------- --- 1 --•------- #4 --------------------------------------------------------------- y1 - ----------- - •--- -- --- ------ - --- ------ -- - - -- - pared this applica+ion and tha+ the work will be done in accordance with San Joaquin County Ihereby certify that I have pre ! ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed}-.- ----- -- { net and/or Contractor) 8r• - - 1._ "-------------------------------------- ----------------------(r+ (Plot plan, showing size of lot, locati( f system in relation to'wells, buildings,- etc.,'can be placed'-on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---. DATE -------•------------------------------------------ REVIEWED BY ------•--------------------------------------------------------------------------- DATE--- BUILDING PERMIT ISSUED---------------------- ----------------------------------------------------- ----------•----- ----- DATE-------QCs-rte--,- --•------------ -•------ ------------ Alterations and/or recommendations---------------------- ------------------------------------------------- ------ -------------------------------------- ------------------------•----------------------------------------------- FINAL INSPECTION BY:.-... -- 9-.y-S y -•---------------- ------------------ - Date-- - - ---------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street ; 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street Stockton, California l Lodi, California Manteca, California Tracy, California ES-9-2M ID-52 Revised W-21DO