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APPLICATION FOR SANITATION PERMIT Permit No. _..!_------- ..-_ (Complete in Duplicate) 5 -�/�- ' Date Issued 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 Ordinance No. 549. JOB ADDRESS AND LOCATION------- - ------ --------------------- - - Owner's Name----- -- E --•, '"'' i't. ---- ----------------------------------------- Phone------------------------------------ Address--------------- f�~ ----------------------------------------------------------------•- ---------- ----- - -------- Contractor's Name--- ---- -•- ------ --- -- - ------------------------- Phon�!.:l Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®---- Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size _ ° —------------------- Water Supply: Public system ❑ Community system I❑ Private Er�`Depth to Water Table- _ ft. Character of soil to a depth of 3 feet: Sand ❑ ravel ❑ , Sandy Loam ❑ Clay Loam `Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , _ (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic / Distance from nearest well/---- � - - -..?_Distancefrom foundation-_ e -hMate�a-l_ _l- ____________ No. of compartments------ -- ----- - ,Si* 1?^L/h.3 GLiquid dept - -------Ca Capacity _ d_ q? Disposa� ed: Distance from nearest weal E' !'_. Distance from foundation_-2.Qf-.__-- Distance to nearest lot line_, ;W-_-- ® Number of fines------/---------------_ __ '`Length'rof each line-- 6.5-`----------------Width of trench _____R "_______________ Type of filter material__6"- ---- Depths of filter material____- pFTotal length__ i0_1________________ in -------------- Seepage Pit: Distance to nearest well---------------------- from foundation!--.--------------Distance to nearest lot line__.-___-___-___-_ ❑ Number of pits.---------------------Lining material_'_Ar------------------ Diameter-----------.-----------Deptk--------------------------------- Cesspool: Distance from nearest well______________i-Distance from foundation_ ------------.-----Lining material-------------------------------------- - � ❑ Size: Diameter------- ------------------------------Depth--` --- ----- -----------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest wolf---------------I------------- __r=___--VrDistance from nearest building.-_____.___________-__-_____-____---._. ❑ Distance to nearest lot line -- ______ o" �11% I -------------- -Remodeling and/or repairing describe :_._ ____ g / p 9 I ) f r-, .ter =. -.G_xx--------- -- _ ' 1 \� ---------------------- -----------------=---------- - -- -- •----- -------- -------------------------- i = -------------------------------------------------------- - ---------- -- ----- --------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ I hereby certify that I have epared this applicationaril that the work wlh6e done in accordance with San Joaquin County ordinances, T�_� d ru s nd regulaf ns of the n Joaquin Local Health District. Si ned� g }------- --, --- -�-:---------:--- --- --- - ---- ------------- ----(Owner and/or Contractor) By:------------------------------ ---- --- - --- ----�/1��-"r ---- ---------------{Ti+le) --------------------------------------------- 1 (Plot plan, showing size of lot, loc tion of system in relatio ells, buildings, etc., can be placed on reverse side). FOR DE ARTMENT USE ONLY APPLICATIONACCEPTED -- --- -------------- - -- --------- ----------------------------------------------- DATE.r--------------------------------- REVIEWED BY------------------------ ---- �- . DATE_--� __-- BUILDING PERMIT ISSUED------ - ------------- --------------------------------------------------------------------- DATE----- ^ Alterations and/or recommendation------------------ -------------------------------•------ --------- -•-----------------------------•---•----------------•------- - -------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------•-------------------------------------=-------------------------------------------------------------------------------------------------------------------- ---------------------•-•-------- 115 FINAL INSPECTION BY:. 11 -------------------------- Date--------- ---------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revisea 1.57 F.P.CO- t