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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued -//n-- 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 complian e with County Ordinance No, 549. 4j-e la- JOB ADDRESS A D LOCATION. --- ---f _ '4 �" "___".•__"" +J , 1�-� `ham U= ------------------------------------ -------------- -- - --- - -------------------- Owner's Na a-- --------------- •------- - ---- ------------ - ------•-------•--------------------------- ---------------------------------- PhoneZ-31`-------- Address....... .. _U_^ --�-g6- ---------- ---- ---------------------------------------------------•------------------------ --- Contractor's Name--- ---- --"-------------•------------------------•------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence 2--"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motgl ❑ Other F-1 l Number of living units: __I Number of bedrooms -Z--- Number of baths _1"____ Lot size _1""O_�__ X_/_V-_+�_ Water Supply: Public system El Community system ❑ Private [Y/Depth to Water Table,30_ ft.C4,_ --------------------- Character of soil to a depth of 3 feet: Sand,❑ Gravel E] Sandy Loam Clay Loam ❑ Clay E] Adobe Hardpan E],�✓JJ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publir� sewer is available within 200 feet.) j � Septic ank: Distance from nearest well C90 _____Distan e Info ation-----/__ ------Mater a ___________ _ t No, of compartments___________�_7_ g I f`f Size x Liquid de�th . -- Capacity u Dispo i Field: Distance from nearest well_____ Distance from foundation__0 /__.---Distance to nearest lot li Q Number of lines_______J-41 ___" _ ,_Length of each line_____- "_"��_ Width of trench____ �- 4 f Type of filter materi _ l7 �-Depth of filter materiaL______I__ ---------Total length------- ------------------------------- Seepage Pit: Distance to nearest well----------------------Distance from 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----------------------------------------- El Distance to nearest loF line. Remod ' d/ r re ng [ ribe ----------------- -- " - -- ----------- -- - _ ,-_ _: _ -_______ __ ______ ________________________ _____________________ -------------------------------------------------------------------------------..-•----------------------------------------------- ------------------------------------------------._------------------------------------- ---- 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 rules and regulations of the San Joaquin Local Health District. (Signed)-�r------ ------ 0", ------------ --------------------------------------------------------------------------------------------(Owner and/or Contracto By:------------------------------------------------------------- ------------------------------------------------------------------(Title)------------------------------------------------------------ (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------- - ---------------------------------------------------------- DATE f-� --------- REVIEWED BY-------------------------------- - - ----- ---------------- • ------------------ DATE UILDIN PERMIT ISSUED Alterations and/or recommendation --------------------------------------- DATE--------- ik s. --- --------- -- --- ---------------------------------------------------------------------------------------------•------------------ •------------------------------------------------- ------------------------ ---------------------------- ----------------------------------------- -----------••------------------------------ ---------•------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- •----------------I---------------- ------------------------------------------------------------------------------------ ---------------------- FINAL INSPECTION BYr!`��_______` "� Date ----------=------------------------------------------------ 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