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APPLICATION FOR SANITATION PERMIT Permit No. __ _______ (Complete in Duplicate) �� Date Issued ___7A _ �. Applica=ion 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 Ordinnce No. 549. .fiQq JOB ADDRESS AND LOCATION___ _ ___ _ ' l -------- --- 1W Q �� OwnersNa -=-��----U --------•- - - - - ------`------------------------ -- --- ---------------- ------------ -- - - Phone--�-�-------------------------- A ---------------- ----•- --- -------•--• l A2111 Address. ^---)--------13-`�--�- ----------------- . ContractorsName-----`--------------- ---••-=--------------••---- ---------------••--•-- ------------------------------------•--•-------------------- Phone------- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ //Motel ❑ Other ❑ Number of living units: ---------Number of bedrooms _ •_. Number of baths J____ Lot size Water Supply: Public system ❑ Community system Dd' Private ❑ Depth to Water Table ft. Ch-6racter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam f d Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Pre4jous Application Made: Yes E] No W New Construction: Yes No ❑ I TYPj OF INSTALLATION AND SPECIFICATIONS: :j,�(No septic tank;or cesspool petroitted if public sewer is available within 200 S�p�c Distance from nearesi el _ _Distant . Pm foundation .__: eriaf _�______._________.__ r e •.i No.".0f comparfinents--- ---- ------------ ---X_-^V�-----------Liquid depth- --- - Capacityr-- ---- A , 1. - Si --- a Disposal eldi Distance from nearest well. _ _._.Distance from foundatio. �j " Dis#ante to nearest lot Eine_______ _______ _ rf� n - Number of lines._..___....__ ^'_Length of each line____` _ 3 Width of trench-. ,_ ____________________ n------- ,,� ..Ty.pe.of_filter.material-__,�•� -- _ � Depth of filter material--'I -----------Total length______ _____-�`�________-___...__ Seepage Pit: Distancb-to nearest we11_.._,__T____'�=y.Disfance from foundation--------------------Distance to nearest lot line--_-.---_-.__.__ ❑i Number of pits.-----4--------------Lining`'material------------------------Size: Diameter-----------------------Depth------- ------------------- Cesspool:- Distance fiom nearest well' Distance from foundation--------------- Lining material_____________________________________ Size: Diameter -_.. .A__ __ ____________ De th a=- _:___. --. _ Lr 6 i„Ca actgals, r !Distance from nearest building._____________________________.__________. Privy:l � Distance from nearest well_:___.._______.:_------------------------------ i- w Distance to nearest lot Line- -_-__-___—_r--: -.-- ----------.. -•-----=---`---------- i ------------------- r • _ t . . �iRemodeling and/or'repairing (describe):-- -----------------------------"-----------------------------------.- -----••-------------------•-----------•-=--•----•-------------••------•--------- .-..----- --------------------------------------------•---,--------------------------------------------------------•-----------•--- ------------- ---- -----------=---------------------------------------------------------------- -•--•-------------------•-------------•----•-------------- --------------- ------- ------- -----------•------------------------------ # # �,. I hereby certify that I have prep red this application and that the work will.be,done in accordance with San Joaquin County' ordinances, to la d,rules_and egulat' ns,.of.the San Joaquin Local Health District. (Signe .... ----------------- ----- . --------- ------------------- (Owner r Contractor) i ,- -- ,. _, ...�. a e and oR By:.... `-- -------------=-------------------=---- ------ ----------------------•--- = ------- (T�tiel'---------------------------------------------------------------Y (Piot 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 - ----------------- -------'------- ------------------------------------------------------------------------- DATE ------•------------------- BUILDING PERMIT ISSUED------------------------------------------------- -•---- � -------- ------------------------=------------ DATE.- -------------- ----------------------------------------- Alterationsand/or recommendations:------------• -----------------------------------------._.........-•-------------------------------------------------------------------------------------- ---------- -------- ---- ------------------------------------------- ------ ---------------------------------------------------------------------------------------•-------•--------•----------------------------------------\`] -------•-------_------------------- ---------------•-------•--------------------------------------------- -------------------------------------------------- ------------------------- - "J r : FINAL INSPECTION BY:= Date_---- SAN JOAQUIN'LOCAL-HEALTH DISTRICT ! ' F � 130-South American Street 300 West Oak Stree! 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revised W-2100