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JJ APPLICATION FOR SANITATION PERMIT Permit No. .__i- _ (Complete in Duplicate) r' ' - + Date Issued _ Applicaa-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 compliant with County rdinance No. 549. JOB AD l:Z?sem _cDRESS AND_�•�.�,ia,s _ CATION-r __' _ . . � ----------3^_ Owner's Name- -A -------------------------- ------------------ ---•-•-- — ., --••-----•- ---- - ----- ------ --- ----- Address ------ ----------------------- Phone-------------• ------------•-•--•--- ---•• -!p 4 -----------• ----------- - ---------•----------- ---------- Contractor's Name---- __ - ------------------------------- - Installation will serve: Residence ) Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units. _�_=___ Number of bedrooms02 Q � ______. Number of baths ______.- Lot size Water Supply: Public system-El Community system ❑ Private'k Depth to Wafer Table l-P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loarnx Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes [I No EX New Construction: Yes R] No ❑ .f TYPE-OF INSTALLATION AND-SPECIFICATIONS:- (No septic tank:or cesspool permitted if public sewer is available within.200 feet.) 1 Septic Tank: Distance from nearest well__o3 ?_ ---_Distan fro foundation`_.A/-V Material No. of compartments_._-------_--.......Size-_��__7 -- -r- ---Liquid depth------ - - --- :Capacity_� ------- Disposal Field: Distance from nea' strweil -D'.-__-!'-Disfance from fcundafion__P V-..__-___._Distance to nearest I t li e----------------- -o C Number of.lines___' ___' "'"� - _ _ L•engthf each line___ -U�__ f��i Width of trench__ __ Type of filter materia T A P f filter material` ` ----_---Total length._LG'--------------------------- YP Depth o Seepage Pit:'- Distance to nearest wel -rTTlDistance.fr m fou anon___ _________Distance to nearest lot line- Cesspool: Nuimber of its__ J P -------------Lining materia i Size: Diameter----c��j-y---------Depth--„°�r�-' I -------------------- Cesspool: Dis#ante from nearest'well_________,_-__._Distance-,from foundation____________________Lining material__.________._____.__-___..- t ------- ❑ Size: Diameter---- --------------------- ------ Depth ---- ---- ---- _Liquid Capacity_ r f q -------------.--gals. Privy:' Distance from nearest ' well------------------------- ______________________-__-Distance from nearest building❑ Distince'to'nearest lot line _ ------------------------- ' - ---------------------------------------------------------- ------------- Remodeling and/or repairing (describe)__----------------------------- ------------ I;hereby certif hat I have prepared this application and that the work well be done.in accordance with San Joaquin County ordinances; Stat ;'and rules an egulations of the San Joaquin Local Health District. t R (Signed): _ _ ---------------------_--.w ....,.,� = . - - (Owner and/or'-Contractor)- - --------------- C k BY: = •-------- • --- g (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 ACCEPTEDBY_-_ _ -------------------- -------------------- DATE-- -- - -REVIEWED BY --------------------- ---- -------------------------- DATE-------------------------------------- 1LD1NG PERMIT fSSUED__. ------------------------------------------------ - ------ DATE--------------••- ----- �: ----------------- Alterations and/or recommendations__ ___________________________----_•_- ---------•--- -- ---•--•--------------••---------- --•-----------------------`--------- ---------------------------------------------------•------------------------------------- -------------- _____ ___________________________•-____.______._..________.- FINAL INSPECTION BY:. -- -------------- Date------ _�_ -----�� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streot 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stock+on, California Lodi, California Manteca, California Tracy, California f ES-9-2M : Revised W-2100