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APPLICATION FOR SANITATION PERMIT Permit No. I (Complete in Duplicate) Date Issuedy ------------ ;y 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 Or&nanc"oo- 1549_.---, ..5 d _ JOB ADDRESS A D LOCATIONQ __ - E�'' --- ---- - ------------------------- phone- Owner s Name_ ____________ ________ ------ ---- - ----------------- ----"------------ --------- ----- Address----------•-- � - -- ----------- ----------�- --------------- " Contractor's Name----_. -------- Phone---------------�*�- L --------- - --- Installation will serve: Residence . Apartment House ❑ Commercial ❑ Trai r Court ❑ Motel P Oth r Number of living units: __�'_ umber of bedrooms _�_ Number of baths -_- __-- Lot size __ -- -- Water Supply: Public system [Community system '❑ Private ❑ Depth to Water Table -------- ft, h of 3 feet: Sand Gravel ❑ Sandy Lo�PN Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a dap} �.y Previous Application Made: Yes F-1 No New Construction: Yesa ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public se%y er is available within 200 feet.) . n------.M t ri i------------------------ ---- - ------------- rest fro `oun _action---"�_-(.l Septic ank:5 Distance from nearest well_ -- Capacity--__ r� . ----Liquid id de th------------ �.� No. of compartments-------- ize q i? 'Distance from foundation-_ ___ Dispos Field: Distance from near. well.__- �_ _._-.Distance to nearest lot lin -r ------- --_ . Number of fines___ _-__-- --- ---- Length of each line--- ____- ----Width of trench-_- _- - - ------------ Type of filter materih�� epth of filter material ... -- Total length l Yp - Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot lin e__---"-_""_---".. us -------Size: Diameter---------------- De th V i ❑ Number of pits-------------------.--Lining materia4_"--""__--" -- ---- p ' Cesspool: Distance from nearest well-------_- �n-.--Distancerfrom foundation--------------------- material------------------------_-- _-- , 1 Depth----------------------------------------------------Liquid Capacity---------------------•---- gals. ❑ Size: Diameter---------------------------------- LA Privy: Distance from nearest well-- ----------------Distance from nearest building------------------------------------------- ---------------------------------- ❑ Distance to nearest lot line----------------------------------------------------------- ---------------------------- Remodeling ------------------------Remodelin9 and/or repairing (describe): -------------• •---------------------.-•--------- , •-------------•-------- ---•-•------------•-----:------------------------ --------- ------------------------ -----°--------------------------- •------------------------•--------------------------------•--•------------------------------------------ --------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stiffbjaws. and rule and regulations of the Sa"4r Jdaquin Local Health District. _--"-_-----_-----------------(Owner and Contractor) onrctor) Signed] 2- ---- ------ - - �I --------=---------------------------- ------------------------ 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 DATE- ` ------------------------ APPLICATION ACCEPTED BY---- - ---- -------------------------------------- REVIEWED BY----------------------------------- -• - ----------------------------=---------------"--------------.-------------- ------ DATE �„!4 --------------------------- BUILDING PERMIT ISSUED------- - ----------------- ------------------------- ------ ----- ----- DAT E------------7—>-------- ------------------------- 'Aw------ It at' nsand/or com endations: > " -- ------ ------------------------------------ =------------------ ' --- ----- .`.f- -h.. -------------------------------------------------- ------------- -'------------- ----------------------I----------------------------•------------------------------------------------------------------------'----------------"----------------------"-.... .p i --------------------•------------ -- ! r - -- ----- -- ---- ' FINAL INSPECTION BY: = ------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C' Street 130 South American Street 300 West Oak Street 132 S Y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Revised W-2100