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`ri t APPLICATION FOR SANITATION PERMIT Permit No. ........ (Complete in Duplicate) -yU lP Date Issued ___-..� _- Applica4-ion 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. n JOB ADDRESS ANi LO TI N.... �� f 'p - , 0-11V P d_- :c 0------IC15 - Owner's Name . !� g F.. -------- -------------------------------- Phone------------------------- - ti Address--------- ... ` ----------------------------------- ' 3 ------ Contractor's Name-----------`-rs �---� - - ----------------------------------------------•------•---------•--•--•----. Phone----------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ +her ElNumber of living units: __ ____ Number of bedrooms _ Number of baths _:�___ Lot size _______ __C--__-- __-----__________-_ Water Supply: Public system ❑ Community system ❑ Private 9Gr•6epth to Water Table _2-24t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [n_New Construction: Yes n IVb ❑ 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___h.` --Distance from foundation_-__. __d-----Material_________ ._----__P_YF_/ No. of compartments---------- - ----Size------------------------- -----Liquid dept-------------------------Capacity------ - � Disposal Field: Distance from nearest we I----&...d._Distance from foundation__ ___._.Distance to nearest lot line_______6 -- Number o; lines_______________ __ ____________Length of each line-------- _-__ Width of trench-----------3-D.- ---------_- Type of filter materiall_� ___Depth of filter material______.-__Total length___-._-./.__�=____�______-_____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 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-------------------------.-------------.-. ❑ Distance to nearest lot line ---------------------------------------------------------------••------------------------------------- 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, St laws, and rules and regul 'ons of the San Joaquin Local Health District. (Signed)--- trelation - �� •- ----••- -- -- •--------------------- -------------Owner and/or Contractor By:..------------------------........--•-•-------------tsysfem ---- ----- ----------------------------------(Title)-------------------------=----------------------------------- -- (Plot plan, showing size of lot, location oftow s, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --------------------------- -�� -- $ ---- ----- -- •----- -- DATE-------------------•-- - ------------------------- - - REVIEWED BY------------------------------ ------------------ ------- ----------------------------------------------------------------- DATE---------------- ---JIM----•-------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------- Alterations and/or recommendations:------------------------- - ------- ----- ----------------------------------------------------•-------------------..-..----------------•------------------- -----------------------------------•---•--._-.-----•-------•---•--•---•--------•---------------------------•---------.------.---------------.---_.-----•-------------•---•--------•---------- •-----•---- -----------•------- FINAL INSPECTION BY—,"44,- - --------------------------- Date----,_- 3'`-•--- ---_� ----------------------------...------------------- 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 t ES-9-2M ; Revised W-2100