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k APPLICATION FOR SANITATION PERMIT Permit No. . '__. - ? b1LJ (Complete in Duplicate) Date Issued Aplical-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. JOB ADDRESS AND LOCATION-------------X216 --- .(3 -y�----E--------j ------------------------------------------------------------------------------------------------------ Owner's Name-----------------------------------------�-1-=_82------iQY0__60-1-7-------------- --------------------------------------- ------------ Phone---------------------------•-------- Address----------------------------------------------------------------------------------------------------------------------- ---------------- ----------------------------------------------------------------------- Contractor's Name---------------------------------------------------�__j---------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ------ Number of bedrooms __;?-_. Number of baths _I______ Lot size _____S_0 __ ------4Z_:_g--------_------------ Water Supply: Public system ❑ Community system Private ❑ Depth to Wafter Table _4_5 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeliff Hardpan ❑ Previous Application Made: Yes ❑ Nor New Construction: 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-----------------Distance from foundation--------------------Material------------------------------------------------- F1 ____- -__.._ __.____________________- ❑ No. of compartments------------------ -----Size--------------------------------Liquid depth----------- --------------Capacity------------- f Disposal Field: Distance from nearest well--_ 15t� ._Distance from foundation_____/U_f__t.___Distance to nearest lot line....... Number of lines----------------I--(_______. __Length of each line_____-_____ _�r�____.Width of trench---------?` .................. Type of filter material___.__.l_�k_0-- (__Depth of filter material___..___ 7---___.___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------------------------------------------ ElDistance to nearest lot Iine----------------------------------------------- ----------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):------_-------------- _____________ __ d , � '97 -� � ,j ------------------------------------------------------- ------------------------------------------------------------- ------- ---------------------------------------- I hereby certify +ha+ 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)--------- ------- -------------------•-------------------------------------------------------{Owner and/or Contractor) B '-----------'-------------------------------------------- Title (Plot pl � showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- --------------- -----------------V - ------------- DATE--------- , REVIEWEDBY---------------•----------:- _-------------------------------------------------------------------------------------------- DATE-------------------------------- --------------------------- BUILDINGPERMIT ISSUED---------- ------------------------------------------------------ ------ DATE------------------------------------------------------------ Alterationsand/or recommendations--------------------------------------------- - ---------------------------------------------------------------------------------------•---------------------- ------------------------------------------------------------------------- ----------- ------- ---------------------------•---------------------------------------------------------------------------------.....------------ ----------------------------------------------------I------I--------------------------•-------------------------------------------------------------------------------------------------------------------_ -----------------------------------------•-- -•----------•----------------- ----------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------I----------------------------------- ------------------------------------- • -----------------------•------------------------------•------- FINAL INSPECTION BY:---------------------VkA,- --------- Date-----------------------3-- ------ ---.- - Y------------------------------- 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-4-2M - Revised W-2100