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;/APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 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. A �I -I.? - JOB ADDRESS AND LOC-ATION-.,.. ?� -------------- - -- ------ -- -------------------------------I--------------------------------- -------- ----- ----- ------- Phone------------------------------------ Own rs Name ------- -- - - ---------- - -------------- ----- ----------- --------------------------- Address-...------_--------------- b ------------- ------------ --- - -- ----- --- ------ ---- ----- - ------ ------------------- --- ------ -�7 LefiA/ Phone ---- - --- ---------- -- ----- ----------------------------------------- Contractor's Name-----------),r4--- --- --- --- Installation will serve:, Residence Apartment House E] Commercial E] Trailer Court E] Motel E] /other E] Number of livihg units: ---/ Number of bedrooms __/_ Number of hs _/_ Lot size -----P? Water Supply; Public system [] ..Community syste 0 Private: Depth to Water Table -------- ft. Character of soil to a depth of 3 fee-'f: Sand Gravel F-1 Sandy Lo ly Loam E] Clay E] Adobe Hardpan El E] Previous Application Made: Yes No New Construction: Yes ;�No El' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank Distance from nearest well-y-- __----_-_Distance from foundation--------------------Material------------------------------------------------- EIPE "to No. of compartments-----J-------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal FFi e 11 J.- Disfance'fr'om n`eareA well, �__m--------Distance from foundation. Distance to nearest to line,__.,.�. ... El Number of ......�4,_Lengfh of each line_-__- __---_ ---Width of trench------- ?0 , 4-1 -b ---------- Tyl6e of filter materiaSX_ej64.__,__Depth of filter material-------- -- --------Total length--------- ----------------- Seepage Pit: Distance to nearest well---------------- -----Distance from foundation--------------------Distance to nearest lot line---___-_-____---_ W ❑ ine----------------- 171 Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well----___ ---_Distance from foundation-------------------Lining material------------ __ ____________________ Size: Diameter_ ------- -------------gals. 'Distance fr6m nearest'well------ -- ----------- -------------------------Distance from nearest ing' ------------------------------------ ❑ Distance to nearest lot line------------------------------------ --------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----- ----------- -- -- --- -- -- ------ ------------------------------------------------------ -------------------- ----------------------------------------- ------------------------------------------------------------------------------- ----------------------------------------------- ---------------------- --------------------------------------------------------------------------------------------------------------------------------------- ---------------------"I----------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------- I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d eregull tions of th San Joaquin Local Health District. . .. .... . .... j.and/or 06 tractor) (Signed)---- -- ---- --- ---- ---------- ---------- -------------------- ------------------------- -- -----Wgr n . . ............... By:---- �i--- -- ------------------------------------------------------------------------- (Title) ------ 70 -ntractor) 4 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---------------- --------- REVIEWED BY-------------.---------:------------ . ----; *-U. ------------------------------------------------- DATE V BUILDING PERMIT ISSUED--------------- -------------------------------- ----------------------------------------------- DATE Alterations and/or recommendaf ions ---------------------- --------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ------------------------------ -------------------------------------------------------------------- -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------- ---------------- --------- --- ------- -------------- ---------- ----------------------------------------------------------------------------- FINAL INSPECTION BY:------- 7; - 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