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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued ___ __�--�115 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. My:�£, ST k' f JOB ADDRESS AND LOCATION------�A_ _4----:��¢I_/1'�"4.�i. Ii 1� -----------------------------------------------------------------------------�r Owner's Name.....01�57G1L-CA/a...... ---•--------------------------------------------------------------------- Phone nJ_J_8 F----� . Address.............. ------ vr----- ------------------------------------------------------------------------------------------------------------- Contractor's Name--------lo�.,_ ..... - ,fo41 Jf---/ZV ---------------------------•---- Phone- � Installation will serve: Residence E] Apartment House E] Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Nu ber of bedrooms ________ Number of baths -------- Lof'size ---------_---------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table j6 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay L] Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tarlk: Distance from nearest well-----------------Distance from foundation--------------------Material----------------------------------------------- .. �C_ No. of compartments ___Li Liquid depth -______._Ca acit 14' .I p q P p Y Disposal Field: Distance from nearest well-------------------Distance from foundation--------------------Distance to nearest lot line___________--_-- ❑ Number of lines--------------------------------- Length of each line------------------------------Width of trench------------------------------------ Type of filter material__________ __ _ Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest weli- Q�eC_-Distance from foundation___-__/U-_______.Distance to nearest lot line_c _________ Number of pits__------/------------Lining material---ee_L�_.Size: Diameter____= _ -____Depth------- -o_!_______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-----________________________--_____. ❑ Size: Diameter---------- ----------------------------Depth----------------------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_____________"___-------------------------------Distance from nearest building___________.______...R� ❑ - _ _ __=.: _ _ ---------------------------------------------- -- -----.....--------------�----__-- - � .-..,.�-rte -x�•-:----- � , Remodeli s and/or repairing (describe):-- g?gwl1 11,0--r------ 1Lf-- ,� i-W... ------------ ------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------•-------------------•-------------------------------------------------------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---- �..r r9i r -a NSf--1 '-------------------------------------------------------------------(Owner and/or Contractor) By:. ---- ------ --------------------------------------------------------- ------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - - ---------------------------------------- DATE- -------------------------------- ATE --------- ----- ----- REVIEWEDBY-------------------------- - --- ------------ ---------- - ------------------------------------------ DATE------ f BUILDING PERMIT ISSUED---------------`--------------------------------------------------------------------------------------- DATE--------- V:�? Alterations and/or recommendations-----------------------------------------------------=-------------------------------------------------------------------------- t --------------------------------------------------------------------------------- ----------- ------------------------------------------------------------------------------------------------------------------------------ r ---------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------- 3 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 9-51 Revised W-2100