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v 3 q 4�S I APPLICATION FOR SANITATION PERMIT Permit No, _________________ (Complete in Duplicate) s 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_: IS :-- Owner's Name-------•----------------------- -•--,=-..E d vhf 1-�I-•---•-----�.-----�-V.k<� s' ------------------- Phone 'z• q Address -------------- r� / h� 11}} - ---------------•- -------- Contractor's Name---------•--------•---------•-� --�.�-2.1-�- --------�-f.'1L--------------------- I - - ------ - -------•-------------------- Phone - �_Q,-- Installation will serve: ResidenceApartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms -9--- Number of baths __I-___ Lot size ------- ---------------------------- E Water Supply: Public system ❑ C 1 ommunity system E] Private,® Depth to Water Tablet. � Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: Yes ❑ ,No M New Construction: Yes ❑ No ❑ -} ,L TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well_________________Distance from foundation____._____________-.Material _____-.__�__._--- - # No. of corn artments_ ------------------------------ p --------------------- Size------------------------.-----Liquid depth---- '.C} acit -------------------- Disposal Field: Distance from nearest we,l_�' ---_` 'Distance from foundation_4k g i p y �. r __..Distance to nearest lot line__/Q-�- Number o-f lines-----f----------------------------Length of each line---7-AT_'------------- .Wid#h of french--- 'O Type of filter material__-; -` �� Z�------- --------------- .--- �----Depth of filter material__/-$------------Total length__-7--,, -_---- --------•--------- Seepage Pit: Distance to'nearest well---------------____'Disfance from foundation-------------.------Distance to nearesf lot line-------------- Number •r ❑ Dumber of pits--_____.- _ Lining-material-----------------------Size Diameter -.____ --- --Depth r--------------------------- DistanceCesspool: ';, from nearest well -` _ - ___ Distance from foundation .____'----------- Lining ma#erial___74'4-____--- ❑ + Size: Diameter. -7-1-- Depth----------- - Q ------------------- -Li Liquid Capacity Priv c r �, q p Y gals. Y= Distance from nearest v✓elf._._____-__- ` `''� :F ----- ----------------------_____-_DistanceWorn nearesf buildin ' Distance to nearest lot line._______________________._-____- Remodeling and/or repairing. (describe _____'_____f_- w. . i i . ._,.� ---------I --------•-- --- --------------------------- ----------------------------------------------------------------- ------------------- -----------------•----- ------------------••-------------------- • - ----------------•------•---•-------------•---- ------------------------------ ------------------------.--- --------------------- ----- ---------------------------------------------••- ------------•--••----•-----•---•------•----------------------------------- f----------------- I hereby certify ha I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an rules and 'egulations of the San Joaquin Local Health District. (Si ned r 9 -------------------- -- -- ----------- a -- - --------------------------------------------- $y:.---�-----:-----------------•-----------•---------'-------------•------ - -- - [Title]--- - Contractor) (Plot plan, showing size of lot, location of system in rel ion to wells, build' gs, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED,BY_1 - � ---- -- --- - REVIEWED BY §. ------- F DATE_ _ -------- ------ DATE -•- � BUILDING PERMIT ISSUED_ ----------------------------------------------- -----------------------•---------------------------------------. DATE..---- CA`' Alterations and/or recommendations:-____._.__---------- ---- -:. ---------------------------- ----------------------------- ------------- --------------------------------------------- --------------- ------ ------------------------- ,I ------------------------ ---------- - - ------------------------------------------------- FINAL INSPECTION BY---------- _ _ ' Date-------------- _-/v J ------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT !30 South American Street 300.West Oak Street 132 Sycamore Street 814 Nor+h "C" St�reef S+ock+on, California Lodi, California Manteca, California Tracy, California ES--9-2M 10-52 Revised W-2100