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�3 `y �. APPLICATION FOR SANITATION PERMIT Permit No. .. -- -- -- > I Q ` (Complete in Duplicate) __ __� I r Date Issued ___d __Jr__j'� 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......1_7-11 71--- 01------ ff Owner's Name------------=--------- L__,A. ...----------------------------------------------------------------- Phone------ AddreAddress ss------------------------------------ ------ �__� ( 5 ---------------------------------- Contractor's Name---------------------- &4_4.14�- ------------------------------ ------ Phone----' - Installation will serve: Residence J4, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _� Number of baths'_ Lot size ------ _-___.._..__ Water Supply: Public system 'Community system ❑ Private ❑ Depth to Water Table .21- ft. f' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe k Hardpan ❑ Previous Application Made: Yes ❑ No� New Construction: Yes ❑ No ❑ Pfe�riOh X�41r► � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se _j:)iK Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- N No. of compartments------------------------- Size-----•-----------------••-------Liquid depth--------------------------Capacity---•------------------- Disposal Field: Distance from nearest well-________________Distance from foundation-------------`:___:Distance to nearest lot line________-___-_.-_ a IFEL&-fr'ya 9F Number of lines------------------------------------Length of each line------------------------------Width of trench.---------------------------------- �s r Type of filter material________________________Depth of filter material-------------- --------Total length_____:_.._._______..______________-______ l Seepage Pit: Distance to nearest we P(o_Pl.&'_____Distance from foundation--- S_`___.__.D''f nce to nearest lot line----/A_`_ of p;ts.--/----------------Lining material-CC'.�_ A+_Size: Diameter---�-------------- Number Depth,/- `--------------------- Cesspool:- Tw Distance from nearest well_________________Distance from foundation____________.______.Lining material_____._____________--___.-.___.__.___ ri -;Size: Diameter-------- --------De th ---- ----------- - -Li uid Capacity_ ..--------------- Distance -:------- - Privy: Distance from nearest well--------- from nearest building____.____.__.________________-_...__._._. ❑ Distance to nearest lot line- --- -------------- ------------------------- ...---------------------•--------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------- •----------- -------------------------------------._._..-------- ------------- ----------•---•--------------------------------------------•---------------•--•------------------------------------------•------------------------•--------------------------------- ------------------------------------ -- -11 ------------ --- - ----- ------------•----------=--------------------------------------------------------------•-------------------------•----••-•----------------------------- ordinances, Stat 1 S. and rule prepared this application and that the work will be done in accordance with San Joaquin County I hereby ce i that I have re regulations of the San Joaquin Local Health District. (Signed) - ----------- ( iContractor) By: - �_--------•------- (Title)__ .Gtl • (Plot plan, showing size of lot, location of system i elation to wells, building etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- =4 -------------•-------------••--- DATE-------.-7./ ------------------ REVIEWED BY - ��'�------------------------------------ DATE ---- �� BUILDING PERMIT ISSUED----.-.--:��-- -- - ---------------------------------------- -- DATE--------------------------------------- - Alterations and/or recommendations------------------------------------------------- ---•---------------------------•-------------------------------- ------------ I t t f -----------------------•-•-----------------------------•------------------------------ ----------------•-• ----------------------------------------- -------- -------------------------------------------------------- FINAL INSPECTION BY:. .� --------------- ----------- --------------- SAN ,�--------------- 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 10-52 Revised W-2100