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APPLICATION FOR SANITATION PERMIT Ad'it No. _C1..3....l._._ F 1 1 (Complete in Duplicate)M � 5 Date Issued ____�_l_�.✓'�___Y" Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. F This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_.. ;_��----1---�---�---t-L I-A-_�_�•__ f e-------- - -1-------------------------------------------------------- Owner's Name-------------------------- ' ----- x{� C------------------------------------------------------------------ Phone--- ------- Address---------------------------_-----........ --- ------------ -X37??ice --------- ------ - Contractor's Name_______________________ --- --- •-•� ------�=-- - -- - -- - - - - -�--- ��- �� Phone----�----,�- ---�- --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1_?Number of bedrooms -1," Number of baths-�'YLot size __`ria_'__ C__ G '_________________-___ Water Supply: Public system K Community system '[] Private ❑ Depth to Water Table//# ft. . . • U, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑. Adobe,® ' Hardpan ❑ Previous Application Made: Yes,9 No jX New Construction: Yes Er No ❑ Gy, 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 -t3?LR7Distan f ation__/ma_--- ----.Material---- &g �t - 3------------ No. of compartments-____ ____________Size � - _ _____Liquid ;epth__ `}_, ____________Capacity_.ctvrIN Disposal Field: Distance from nearest well_N� .__.Distance trom fo%a •on_-_-- '____________Distance to nearest lot line------- . Number of lines__]------- _ Lengfk of each line__ c -Q--_ -________-Width of trent'n 4�-'_'_____________._____.__ �----fir------ Type of filter material_ _YAi_1_______________Depth of filter materia__ ___ ___--.y--. Total length__,5-_C-_---------------.----____.___ Seepage Pit: Distance to nearest well___A�a-_-_Distance fr fou dation_.41`--------Distance to nearest lot line_-�*__-__ Number of its _Linin material� _Size: Diameter_____ "_ De � - I� pit ` - g Pth "'�- ---------------- e Cesspool: Distance from nearest well-------_______,Distance from foundation-----------_--------Lining material___----_____________________________ ❑ Size: Diameter--------------------------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------ga Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______________________-.-._-__-__.______- ❑ Distance to nearest lot line------------•------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------•--------------------------------------------•--------------------•-•---•------- --------------------------------------------------------------------------•-•-----------------------------------•--•---------------•-------•-----------------•----------•-------••------••---------------------------------- ----------------------------------- -------:-----------------------------•-•-------- ------•--------------•---------------------------------------------------------------•-----------•---------------------------=------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules andjr'egulatio�9 ns W the San Joaquin Local Health District. (Signed} -- --�-,-- ------ r-- _ 1_�- s{O ner cf Contractor] B------- ------- ---- �em -----------------------------------------------------------(Title}- ------------ {Plot plan, sh ing size of lot, location of relation to wells, buildings, etc., can be plted on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - - --------------------------------------_.-.---.-_.--------------------------------- DATE- REVIEWEDBY --- --------------------------7---------------------------------------------------------- DATE--- BUILDING PERMIT ISSUED----------------- ------------------ ---------------- DATE------ ---------- Altera ions and/or recom ndations _ _ 1t ----- {, --------------- -1 : - f 7�' ------------------------------------ _� - -- ------------------------------- -------------------- ---------------------------------------------- - --------------------------------------------------- ------------------------------------------ ----------------------------------- ------------- ----------------------------------------- FINAL INSPECTION BY----------------- --------Y� _k-------- ------- Date - i-1-1 = ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 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