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APPLICATION FOR"SANITATION PERMIT -,Permit No. (Complete in Duplicate) Date-issued --- �' f 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 1_117..E 'L _C1�Z. �[ - ------------------- Phone------------------------------------ Address------------------------------------d 2D = Contractor's Name -=----'---' ---!/---'---------------------- ------------------------------------------------------------- Phone----- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ElOther ElNumber of living units: -------- Number of bedrooms ___/__ Number of baths Jr'__,,��rr_ Lot size _____________- 4 -_- Water Supply: Public system ❑ Community system ❑' Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g Hardpan ❑ Previous Application Made: Yes ❑ No dam" New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well---�-_-------Distance from foundation....&----------Materi �------- r•[----------------- No. of compartments_____,__-_`Y________Size__ _- Liquid depth__________ -------- Capacity___ Y - /2X 3 'y` r r Dis at Fie d: Distance from nearest _50 --____,Distance from ou dation__-__L __ ____Distance to nearest lot line_________________ Number.of lines------------- _---------------Length of each line___=______1 Vii____-.Width of trench-----------Z`�............... 01 Type of filter material___:7 __it____________Depth of. filter material---------4Cl __-__Total length________________/0,0-------------- S Seepage Pit: Distance to nearest wel!____________________Distanceyfrom foundation------.-------------Distance to nearest lot line_________________ ❑ Number of pits----------------------Lining material-------------_---------Size: Diameter-----------------------Depth--------------------------------_ 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----------------------------------------- F-1 Distance to nearest lot line------------------------=--------------------- --------------------------------- ------------------------------------------------------ Remodeling and/or repairing (describe)------ ------------ -X4!1-__----- --- 7 •. -----L,,t- ¢------ Q-----.-- 0-cam__-------- �"`-4- �- _ --- --------------------•------------------------------- #. ,. ------------•------------ -------------------------------- -------------------------------------------------------------------=----------------- __ _ __ " I herebycertifythat l have prepared this application and that the work will be,do7d rn accordance with San Joaquin County ordinances, State laws, and ti rules and re ulaons of the San Joaquin Local Health bi§trict. j� ac (Signed) -- ------------------------------------------------ �_; '?' ------------(Owner and/or Contractor) By: -----------------------•------------------- ---------------------------- -----�---:------------------- -- (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 APPLICATION ACCEPTED BY---------------------------------- -------------------------------------------- DATE------------- { REVIEWED BY -------------------.------------------ - ---- -- -------.------------------------------------------------- DATE l' 4� -- --- --- BUILDING PERMIT ISSUED--------------------------------------------------------------- DATE Alterations and/or recommendations:------- �J ------- ----------------------------------- --------7------- - - +�AU�C------- � + -----------------�+� r�----------------- �"cc f11��_ _ ass �r %�' 1 ✓{ x< V,-- ----------- y== c -� ------------------------------------------------- --- -- - ------------� ----•------ A� d . --- ----------------- s9---------- s -,�. ------•-- s s X42_ef1 %--------------------------- �---- -- - FINAL INSPECTION BY:- ---------------------- Date------/-->- r 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