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' APPLICATION FOR SANITATION PERMIT Permit No. --- _!- _Z-_-_. (Complete in Duplicate) �� Date Issued 1 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. 549. JOB ADDRESS AND LOCATION____---- - , ` - --------------------------------------------------------------------------- Owner's Name (012 1/ /�� - � ------- ----------------------------------------- Phone---�-0_Nr-l-- ------------- Address-.---------------------------------------------•-- �4!?z f j -- Contractor's Name f.� � fro- � -----�fi7_Zo{----- ----- Phone---- Installation will serve: Residence,K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _-/-- Number of bedrooms _ Number- of baths Lot size _-475d_'�_ --_f-ld_'`__-________-___--_ Water Supply: Public system JZ Community system ❑ Private ❑ Depth to Water Table 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ \, Previous Application Made: Yes ❑ Novi New Construction: Yes ❑ No ❑ 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 well, Ply.__Distances fro �Vfou dation_-_10_ _-___---Materia��---------------------------__--___---_--_. No. of compartments-__--------Z-_--_-----_Sizer_) - �- Capacity--_x� Disposal Field: Distance from nearest wel1140klf._Distance from foundatio 10-_ -----Distance to nearest lot line- __------ xNumber of linesLength of each line.11U_ __�__ Width of trench_s�_5x_!? ---------------- VA Type of filter material__ - . -- --pepth of filter material____:-S----------Total length__�-Q__'---_____--------------- Seepage Pit; Distance to nearest well--- Dh ----Distance fro ��fo��ndation -----_---_-.Distance to nearest lot line-- -__--____. Number of pits_-_--_�--------------Lining material _1S-___Size: Diameter__e33`_f---___.Depth-_-10_.0-----_--------____ Cesspool: Distance from nearest well-----------------Distance from foundation-------------:--___Lining material------------------------------------- ' ❑ Size: Diameter;-------------------- --- ----------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------ ------ ----------------------Distance from nearest building----------------------------------------- ElDistance to nearest lot line-- ----------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---- - ---- ------:�&1------#�'�� ------------------------------------------------------------------------------- ----------------------•----------------------------- ---------------- ------------------------------------------------------------------ --- -- - ------------------------------------------- ------------------------------•----'--------------------------------------------------------------------- ------- = - --------------------------- -------------------------------------------- I hereby certify th have prepared f 's application and that the work will be done in accordance with San Joaquin County ordinances, tate laws a rules and reg tions of th San Joaquin Local Health District. (Signed) �'a r ----- r Contractor) BY:-- ------ - - --------/�` ------- -----------------------------------------------------------------(Ti+le) - aSf CT1 ��. (Plot plan.-shd i ize-of lot, location o system in relation to wells, buildings, etc., can 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------- -------------------------------- DATE------------- �1 REVIEWEDBY--------------------------------------------- ------------------- ------- ----------------- DATE ' BUILDING PERMIT ISSUED------------------------------------------------------------------------•-------------------=--------- DATE Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------- -------------------------------- ---------- -------------------------;-----------------------------------------------------------------------------------------••----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------•---•--------------------------------------------------•---------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------- --•-------------------- ------------------------•------• -' ---------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: -- ----- ------------------------------ Date------------ ' SAN JOAQUINfLOCAL HEALTH DISTRICT 130 South American S+reot 300 West Oak Street 132 Sycamore Street 814 North "C" Street i Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 lI