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j APPLICATION FOR SANITATION P r PERMIT Permit NoV-6 ..(Complete in Duplicate) Date Issued f��j Application 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 Orrd�d--inan/ceejNo. 549. JOB ADDRESS AND LOCATION- � --— 2 -- L•+t / 11� E S/------- Owner's -----Owner's Name------------------------------------- i - ------------------------------------ Phone ------- ---------- Address J-----------------------------*------- --- ---------------•--------------- ---------------------------- ---------------------------- ------------- Contractor's Name A21_r5f7.............. C------------- PhonelA�f________ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ Number of bedrooms-----1,-:'Number of baths Lot size ------ fr]t7_" ------7-j---r----_--- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -,*40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ CiaLoam ❑ Clay ❑ Adobe Hardpan L] Previous Application Made: Yes ❑ No '*r 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 weil_1 __Distance from fo��dation_�40-__._____.Materia!____________________a______ ty_----- �+ No. of compartments.... Size_ -______Capacity A-_.:------- p --------------- _f�C __•- ----Liquid depth-_ `.�_iO_ P Y �{► Disposal Field: Distance from nearest well-"�E�s. --Distance from o ndation__-r_-_-_________Distance to nearest lot line-----4�----- Number of lines_____,/____________ /_�__r___"--"_Length of each line__-1�__-'p. _________..Width of trench.__a_�_�__�y---___________.-_-" Type of filter materia!__/&4&------Depth of filter material::__,1 --____._ p material-'--/f- � --=Total length-----p�•-�.-�----------- -- -------- Seepage Pit: Distance to nearest well_.H -----Disfancejroj# foundation:__49'__.-_.Distance to nearest lot line________ • Number of pits-------O--_________Lining material_ __.Size: Diameter_:-3-*---------Depth_,2_.r'----------------- M Cesspool: Distance from nearest wel!-----------------Distance from foundation--------------------Lining material---_--------------------------------- F-1 -_..__________-- , - ------------ 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):----------------------------------------------------------------------------------- - t, ----------------------------- ----------------------P"ve -----•--------- -----------------------------------------•---------•-----------------------•--------------------------------------------------------------------------- I hereby certify prep re_ this application and that the work wil be done in accordance with San Joaquin County ordinances, State les and ulatio s of the n Joaquin Local He Ith District. (Signed)---------•--------- - --- -=------- - ----- -- --------- --- ------- - -- ------------------------------------ Contractor) BY= ---------------------- ---- -- ---- -- -- --- {Title} dt - (Plot plan,�showing size of lot, location of system i rel ion to wells, buildings tc., can be pPcedon reverse side). O DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- - _ - --------------- �DATE------------ �3 ��} ----------- REVIEWED BY --- ------------------------------------------------------- --- DATE__._.-------- ------- -- -------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------- -------------------------------------- DATE-------- - ----------------• ---------- A terations and/or recommendations-------------------------------------------------------- - ------------------------------------ -•-•---------------------------------------------------- ---------------------------------------------------Z--- ----••--------------------------------------------------- ------------------------------ -- --------•-;•--------------------------- -- --- FINAL INSPECTION BY:-------- 7'`�__�11 i.................... Date----------------'�� 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca. California Tracy, California E5-9-2M 10-52 Revised W-2100