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APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicate) S Date Issued 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 Ordinance No. 549, JOB ADDRESS AND OCATION--- } /------ --------- , TtYiP_T_d.------------------------•------------------------------------------------ Owner's Name----- ENA Phone / ------------------------------------ Address -----------•--Address----_-_----------s� 15-------------------------------------------------------------------------------------------••------------------•-----------•------•-•---------------• --------------- Contractor's Name _�PL-sl l_ it�C'-------------------- Phone 6G Installation will serve: Residence @2- Apartmernt House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms ----- Number of baths ____j__ Lot size ------- _ G r Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -`�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ 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 Tank: Distance from nearest well--.---------------Distance from foundation--------------------Material___________-__-__-_-_____________-_----_ ❑�,f�iS��7�No. of compartments------- ------------ ----Size--------------------------------Liquid depth----------------- ---Capacity--------------------- „ Disposal Field: Distance from nearest well__7–f./-- Distance from foundation___ CF_- ._.Distance to nearest lot Number of lines---- ---------1------------------Length of each line-------- ----------Width of french-_______Z_�__'_'___________ Type of filter material-___5.-,e__A.`_ -Depth of filter material----- _----- Total length----------- -�'__` --------------- ----- Seepage Pif: Distance to nearest well---4o-U.-"___Distance from foundation___- � r -;C _ ..Distance to nearest lot line__-_� _.._.-_ Imo" Number of pits-------I-----------Lining material.& Size: Diameter_-- -------------Depth-------Z_J1______________ 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-__________--_______ ❑ Distance to nearest lot line------------ ---------------- -------------------------------••------------------------------------------------------------------------------ Remodeling and/or repairing (describe) L------J_.691:'e1-•--•-•-•-•-----•-------------------------------------------------------- -------------------------------------------------------- ----------------------------------•-- --------------------------------------••-•-------------------•---•-------------•-•----------------------------•---- ------------------------------------------------------------------------ I 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. 5i ned /77 3 f SF1 `/rC--------------- ------ ------ (Own and/or Contractor) 9 ------- -••--- -- - .. 1, By:_ :. -----------------------------(Title)------ - (Plot 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-------- ----- f----•--------- --------- ---------- --------------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ------------•---------- ---------------------------------- DATE--------------- ------- Alterations and/or recommendations----------------------- --- -- ` _....._.__--__-_ ------- - �-t-- ----------- --- ----- :-----------------------------------••-------------------------------------------- V --------------------- -------------------------------------- ,� _.— .. --------1421- ------ ---------------------------------------------------------------- -------- ----- ---------- -------------------------------- --------------------------------------------------------------------------------------------- FINAL INSPECTION BY: _.: ------------------------------------- Date �' J ``-'- -- ------------ 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 EE-9-2M 149446 ATWOOO 12-54