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n i 1- APPLICATION FOR SANITATION PERMIT Permit No.' o.. -7---__ , (Complete in Duplicate) Date Issued Application is h reby 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. 077-.50--0� JOB ADDRESS AND LOCATION- "-{�[_---- �re/ZP1Z_-- -----r1Q,�t ------------7_._.. .rc's _�-e-1--- Owner's Name--7--- Phone---- -_ ' 1---------- Contractor's Name--------------------------fQJIJL�v� ��-G--------" Phone �"�� d Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: -1------ Number of bedrooms.____ Number of baths Lot size ---1.cc---_ Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table _-_-__-. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ NoA New Construction: YesjK No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ _ _ ./_ Distance from foundation- ----------Material--------- ---- �. F '! � q p. - p y No. of compartments________ Size" _______ - - --------__Li Liquid de th--- r -------------Ca acct --------M Disposal Field: Distance from nearest well� v-------.Distan-_ from f unda n__Gt3______�Distance to nearest lot lie_._ Number of lines__ --_Length of each line___ _ � —�9_-..Width of trench..__A_9C. o-_____________1 D Type of filter materiaLJ_-__ ______Depth of filter ----------Total f_.��_________________1 Seepage Pit: Distance to nearest well_____________________Distance�'froom foundation--------------------Distance to nearest lot line_---------------- Number _._ ----------Number of pits----------------------Lining material-----------------------Size: Diameter'.--------------------Dept h----_---_------------"�'------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-_--_---------------_----------- ❑ Size: Diamefer--------------------------------------Depth-------- --------------------------------------------------Liquid Capacity----------------------------gals Privy: Distance from nearest well______.___`*------------ -------_---------____Distance from nearest building.____..._.___._______._______________._ . ❑ Distance to nearest lot line--------'4'------- -------- f ------------------ ---------------------------- =_= Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------- C -------- --- l` I hereby certify that ave prepare is application and hat the work will be done in accordance with San Joaquin Count ordinances, State laws, and rule and regul ions Qf t San Joa n Local Health District. (Si ned � -- -------------------------- Contractor) g )----•-- ---------------------- ------ --- ---- --- ---=-: By:-------------------------------------------- -------- ------ ----- ---- ---- ----------------------(Title)---r�z- AJAI 1 ------ .. (Plot plan, showing size of lot, location of ste ' relation to wells, b 'dings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------------------------------------- ------ -- ------ ----------------------- DATE - . REVIEWED BY-------------------------------- - DATE-- ---- BUILDING PERMIT ISSUED------- ---------------------•-•---------------- ------------- DATE tp Alterationsand/or recommendations:---------------------- ------ -----------------------••------•---------------------------------------------------------------•-------------------------- .. •--------------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------- ---------- --------------------------•--------------....-------------------------------------------------------------•------- -------------------------•------•-------------------------------------------------------------- --------------------------------- - - ----- -------------------•---------------------------------------I-------- ------------------------------------------------------------- --------------------------------------- // � FINAL INSPECTION BY- ---------------- ------ 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 I0-52 Revised W-2100