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APPLICATION FOR SANITATION PERMIT Permit No...%Q.___?' (Complete in Duplicate) U Date Issued ...../. }7...:�. % I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Oescribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ �� .. ' Owner's ................................ •-•---. ..._. PhonA------'%.I-. d Address._. ......1. A' f -...................................................... ....................................... .......-- Contractor's Name—o. !Ls.r_-•-•-•-_--•-•---••---•---- •-----••--------- ------ --- --------------------------------------------- Phone ......... .................. Installation will serve: ResidenceA Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- I---- Number of bedrooms _a3._._ Number of baths .P2_-_ Lot size _47.A'. . ............................... ! Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ZS ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No N New Construction: Yes k No ❑ -/VA: Yes,} No ❑ 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%,i9 '_'Distance from foundation ` Material.h........................... No. of compartments.....-..... -..Size .......... •. ............... .....Liquid depth -_•-----•----------------Capacity.-/�0'D. Disposal Field: Distance from nearest well./ -------_-Distance from foundation_ZQ............ Distance to nearest lot l e. '......... -1 J1 Number of lines-.-.. 2----- -- ----------- ength of each line.._l ................ Width of+rench.__�S%........................ Type of filter materials epth of filter material..�l _ ---------.-Total length_.. -'-.--.• ................... Seepage Pit: Distance to nearest well ................ ...+..Distance from foMunndation_...._.........._...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_! ;_.._V.__.,�4...__'� .. ]__Distance from nearest building ........................... -- ❑ Distance to nearest lot line ............................%RARA.- _, ................. . - Remodeling and/or repairing (describe) •-•------------------- !......... ._........ ............................... -------- ................... M ............................ •........................................................ -••-----••--••-----------•--------•-•---........................ t 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 and regulations of the San Joaquin Local Health District. -•-----------•-- •-------- ---• ................t ._._........................... (Owner and/or Contractor) sy:.-- (Piot plan, showing size of lot; location of system in relation to,wells, buildings,4etc.,.can be placed on reverse side). - V FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ r - - �_.....--•.............•--........---•- - --••---•---•-•--.. DATE__.&/'%^��..--'.'e��--•-•----....------•--•----• REVIEWEDBY-------------------------------------------------------------------- ._.---------------------------------------- '.'---... DATE.............. ------------.-..------•------•-----------.-- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-•-__ ....................... ------_------_------------ Alterationsand/or recommendations ................. -...------._.-. - ---_--•-•---.-._.-----•-•-•-----.-..----•--------••--------.-...------•--•--•-••---.-.--•--------.-----•----------•-.------ ------•------------•••--••-•-• -•..............................•-----------•-•-•-----•.•••-------------•-•--•-•--...._............._......--------------•---------••---•----------•----•••......•.....-•-- _._.._.....-•------•---••-----...._._...--- ....I .......... .................. .......................... ..._..................................... .............. .................. --••--......._._- ------- --- ---------------------------------------------------------------------------------------------................................................... .......... ........... .---------------•.......... ............. ._.. -----.-- FINAL INSPECTION BY: - - ....--------------- Date _/ .... �..... ---------------------------------------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California, Manteca, California Tracy, California ES -9-2101 . Reviseo 1.57 F-P.CO.