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APPLICATION FOR SANITATION PERMIT Permit No. g�_6 G ^�� (Complete in Duplicate) ` J y IO' Date Issued .__ tdescri pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein ed. This application is made in compliant with o ty Ordinance No. 549. OV il r f r L/— JOB ADDRESS An LOCATION --------= ----------------- EL► y, Owner's e - = --/--- -- 'r f--- G' '`g hone P 1.� --- ------------------------------------- Address � ' � Contractor's Name---- ------- ------•--- --- ------------------------------------------------------------ -------------------------------- Phone----------------------------------- Installation will serve: Residence [t Apartment House E] Commercial F] Trailer Court Moi ❑ ther E]O Number of living units: ___1___ Number of bedrooms _Z_ Number baths .__I__ Lot size ____ _....... ....................... Water Supply: Public system El Community system ElPrivate Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Fj Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 2'/'No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic ank: Distance from nearest well_Cv____Distance f�om fou��n,da�ti''n___ _ ___________Myhe�riaL_____________t.__ __ ___ ___ ____ No. of compartments------------�-----�---Size/ x _l` Liquid de th____L-r�1---------------------Capacity--�------ -�---- ` Dispos Field: Distance from nearest well �-0--_--Distance from foundation_ _ i _ ___Distance to nearest lot line)-- __ Number of lines.---------- _R_________ _ Length of each line____--____ __ j__.Width of trench____-___ _�j /----•-----Type of filter materiai.�'_` ;epth of filter material______ 1_ ______Total length_____________l_ _ ._..___..___. Seepage Pit: Distance to nearest well__________________ -__Distance from foundation--------------------Distance to nearest lot line_____________.__. ❑ Number of pits----------------------Lining material--------------------_--Size: Diameter-----------------------Dept h-------------------------------_- 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------------------------------------------ F1Distance 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) f --._...-•- ----�- -v (Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------ -----(Title)-------------------------------- - --- - ----- ----------------- (Piot 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 ACCEPTED BY--- -------------------------- ------------------------------------------------------------------ DATE__� --------------------------------------------- REVIEWEDBY----------------------------- -----------------------------------------------------------------------•----• DATE------ -----------•---------------------------- BUILDING PERMIT ISSUED----------- ------- ------- ------------------------------------ DATE-- -------p\------------------------------------------- Alt qfi s and or ecommend do � ±.r_ _ _ � !_*- o�/�*^v�_�' 1_�- _ ------ -------- ------------ �_ = b " - �-�C -k Q --------------- - n r � r ------- - ----6�� -------- ----.---- --- 1 --------------------------------------------------- ------- --------- ----------------------- ----------- 4---------- /�.?/ FINAL INSPECTION BY.------ ----A-------- ------------- 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