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S OIL APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) (Q Date issued . ____ p pplication 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 Ordinannc�e9 No. 549. JOB ADDRESS AND LOCATION--- 2-— ------- k ,Elf _ Q/�. ------ 4". r.5 ". ne,&eo------------------------------ Phone. 1.4? -r i Owner's Name------------------------------------ ------- Address-------------------------------------•---_- h'!,�' --------------------------------- ----------------------------------------------------------- it ....-------------- II __ Phone____ ' Contractors Name--------------------------- --- .f��C�------��--------------------' ---'---------------------------•---•-- �"��-----•- Installation will serve- Residence Pf Apartment House ❑ Commercial E] Trailer Court ❑ Motell❑ Other-10 1 " Number of living units: -1--- Number of bedrooms.3--- Number of baths __j---- Lot sizFAt.Water Supply: Public system Community system ❑ Private ElDepth to Water Tabl Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ dobe, Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ql_c#�W_y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pti ` Distance from nearest well________________Distance from foundation-------------------.Material-------------------------- .__________________-. No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity7l------- ---------------- s Distance from nearest well____--------------Distance from foundation--------------------Distance to nearest lot line________.___.._.. a Number of lines-----------------------------------Length of each line-----------------------------.Width of trench------------4-------.------------- Type of filter material_________________________Depth of filter material_____________________-Total length__________________h_______________�W 4 � , - 1 _ al a A,[' See a e Pit: Distance to nearest well___Ii" ___Distanc fr fo ndation__________ __._.Qistance to nearest lot Bine__ Number of pits-°-../-------------Lining mat erial---------_____` --.Size: Diameter-=f--c�- -------.Depth_.a_ - Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material--------.------I___________.__.__ 'y ❑ Size: Diameter-------------------------------------Depth----------------------•----------------------------Liquid Capacity------------II--------------gals. Privy: Distance front nearest well------------------------------------_-------------Distance from nearest building -- d �� ll El Distance to nearest lot line ----------------------------------------------- ------------------------------ --------- ----- ------ ----- --------------------- Remodeling and/or repairing (describe)-------------------------------------- ------------------------------------•-------•--------•---------------------- ---------------------- ---------------------------------------------------------------i_______________--.----------_---------------------------------------------------------------.--------------------------------- I= ----------------------------------••------------------•-----------•-------......----------..--.-_•--------------------------------------•-------- . _________________________________________________________________________________•-____________-___._-_..______.....-.______.-____________________-_-_____________.__._______.___._---____---._________:______..____.__..-_... f 1-hereby certify that I e ared this applicafi n and that the k will 3e done in accordance with San Joequin Caun+y. ordinances, State laws, an rules an eg+ti ,ns of +h an Joaqu'` 0 1 H It isfrict. hh (Signed)----------------------------•------- - ---- /k. ------- - ---- -- ------------------- -------------------- Contractol By:------------------------------ --------------------------•-------------------------------- -------------------- - - ----(Title)--- - -t=t--____� --------------------- (Plot plan, showing size of lot,.location of system in relation to buildings, c., can be pla ed on reverse side). 1 FOR DEPARTMENT USE ONLY II APPLICATION ACCEPTED BY-------- 1--------------------------- -- -----------------------0_8DATE----------- REVIEWEDBY -------------•-------------------- 3------ ------ DAT --------------------------------- ---------------------- BUILDING-PERMIT ISSUED--------------' ---------- DATE-------------------------------------I----------- ---------- }1- 1 .1 ' Alterations and/or recommendations:.---------------------------- ------------------------------------------------------ -•-------- ------------•-------------------•-•-----1............._.._-_ --------- ---------------------•-----------------------------_-------------•--------------------------------- -----------------------------------•-------------------------------------- ------------ a _ ----------------------------------------__------_-----------------------------------------------------------_--------------------_--------------------------------------------------------------.-----:F---------------------- 3 i T ---------------_-----------------------------------------------------------------------__. _ __...- _. _---_-___.-_.-_____--_ -._._______________--_._ -______-_-____________...___--_____________�_____________._______- FINALINSPECTION BY-- -------------------`--------------------------•---------------- Date------- ---- ---- ----- -------------------------- -------------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California • .I WOES c4-2M 10-52 Revised W-2100