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APPLICATION FOR SANITATION PERMIT Permit No. _ __ _ (Complete in Duplicate) s� Date Issued �47H+a,9'3 OiF 25.3—12-0- f ApplicaZn7iisherebyy made to the San Joaquin Local Health District for a permit to construct an4 i all the work 4ein described. This application is made incompliance_ with County Ordinance No. 549. N YO JOB ADDRESS AU4 LOCATION. diir - 'U -� sc t Owner's Name---- e --------- -- ---- --- �s-------------------------------------------------------------------- Phbfie------------------- -------- Address-....... -------Address_--•---- --- Contractor's Name----------------------------- - -------- -------------- ------------------------------- -- •---F - -- --- - Ph -------------------------------- Installation will serve: Residence A t ent House Commercial ❑ p ❑ ❑ Trailer Courts[ Motel��j Other ❑ Number of living units: c1__-- Number of bedrooms .__,x_ Number of baths Q--- Lot size _ Water Supply: Public system ❑ 'Com`m`unity system ❑ Private [ •Depth-Fto Water Table ! ft. l Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa MA Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes p No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if iiublic sewer is available within 200 feet.) 0 Septic Tank: Distance from nearest well_. _�Q_--- _-Disfanct�} from foundation__A-0-------,Maferi I-- - - �`�`� ----------- X11 41 No. of compartments--------- ______Size_._ x_- _ Liquid depth----- ______Capacity... C? -- 4 Disposal Field: Distance from nearest well__/E�b '_Distance from foundation____-lcO--„--Distance to nearest lot lin!e:� � Number of lines__________/_______________________Length of each line-------_g �----Width of trench of filter material_____-7_ .�Depth of filter material___-__/__ --------Total length__-________,2-_�_________________ Seepage-Pit: Distance to nearest well ___________________Distance from foundation__________________Distance to nearest'Iot line___________-_____ ❑ Number of pits--------- ------------Lining material------------.----------Size: Diameter------------------------Depth----Y___-- --- ------------- • Cesspool: Distance from near St we11__�QA-Distance fro foundation-'-s 0--__-_-Lining material-.-__ ___ -- _ Size Diameter____ --- -- Depth________ --------------------------------------Li uid Capacit _ ___ Q9_ Privy: Distance from nearest well _____ _________ _______________ ________Distance from nearest building------------------------------------------- F1 _____________ _ ________________-------❑ Distance to nearest lot line---------------------------------------------- % K Remodeling 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, State laws, and r s nd regulations of the San Joaquin Local Health District. ed _i---------------------------------------------------------------(Owner and/or Contractor) (Sign } By:---------------=--------------------------------------f�m ---------------------`--------------(Title)------------------------------------------ -, -----.--- - - --------- (Plot plan, showing size of lot, location of n relation twells, buildings, etc., can be placed on reverse side). .. FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY ^ =_ = - DATE----------------- ----------------------- ----------- --+ _ REVIEWED BY--------------------------------- = `-- - - -_ -------- - ----- -------- ----------------- DATE------- . - ---------------------------------------- BUILDING PERMIT ISSUED---------------------------------- ------------------------------------------------ DATE-------- -- -------------------------- Alterations and/or recommendations---------------------'------------------------------------------------------------------------ ---------------------- -------------------------------------•-------------------------------------------------------------------------------------------------------.._------------------------------------------------------- -----------------------•-------------------------------------------•-------------------------------------------------------------•--------------------•---------------------•-------------------------••----------------------- --------------------2------------------------ ----------------------------- ------•-------------- FINAL INSPECTION BY---------------� --------------------------- Date-------------------- -------------- --------=--Vii'-------- 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 B-51 Revised W-2100