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Cl YApplica-1-ion APPLICATION FOR SANITATION PERMIT Permit No. __�__-�_1_ ____.- (Complete in Duplicate) Data issued _3�1is 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. � �,I r JOB ADDRESS AND LOCATION.../-y-DY. _ J1/� r Hr � ry f I Owner.'s Name--�1-r I_L_ = �.t f 1_-_~-w_-�------------------------------------------------------------------------------ Phone------------------------------------ Aciclress........... I.A. E. _ --------------------------------- ------------------------------•----------------------------------.------------------------------------- ------ Contractor's Name------ w_�1_-'�-�`-�-------------------------------------------------------------------------•------ --------------------------- Phone----------------------------------- � Installation will serve: Residence IZI Apartment House [-] Commercial ❑ Trailer Court ❑ Motel E] Other El f Number of living units: __I___ Number of bedrooms __�3___ Number of baths _` . _ Lot size _Z0__'5--- ___________________________ Water Supply: Public system ❑ Community system ❑ Private IN Depth to Water Table ___:____ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam p Clay Loam ❑ Clay ❑ Adobe 0 Hardpan ❑ Previous Application Made: Yes 0 NoX 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 we _,S�-______Distance from foundation_1.0-____-____-M'ateriaL_ _�A...w99i No. of compartments----__2----------------Size-- -- -- �-------Liquid depth------`.---------------Capacity-- Disposal Field: Distance from nearest well---��dDistance from foundation--/_P-_(--------Distance to nearest lot line---- Number of lines------------�...............Length of each Iine__ -O__Y.1,0-0-1--Width of trench-- -----X_5_1---------- + Type or filter material`_ _' ¢.!-G---1 ►dpi pf filter material ___)1__ ---------Total length___ .___�__ ----- --- Seepage Pit: Distance to nearest well___________ _________Distance from foundation--------------------Distance to nearest lot line-_______________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-,------------------------------- Cesspool: Distance from nearest well_________________Distance.from foundation-------------------- material_-_._____--____.------_____________. f❑ r,r Size: Diameter------ -------------------------------Depth----- =r----- ------Liquid Capacity----------------------------gals. Privy:, Distance from nearest well---------------:--------------------- -----------Distance from nearest building-------------.___--.-____________-_____-. `❑ + Distance to nearest lot line------------------------------------------------------------- -------•---------------------------------- Remodelin and/or repairing describe :'_._ __ _:1 _t _____ ___--------------------- _________ �• CS Gt.1- ---------------------------------------------------w---------------- -- ---------------------------------------••--------------------------------------------------- ------- --------------------------------------- r -------------I--•--------------`------------- •------------------------------------------ 1,hereby certify-that I Have prepared this.applicafion 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)------ -- ------ ------(Owner and/or Contractor) 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 APPLICATIONACCEPTED BY------------- --------- --- -------------------------------------------------------------------- DATE_------ ------------------------------------------------- REVIEWED - - • - - REVIEWEDBY----4-------------------------------- - -----•-- -----------------------------------------------------------------------.. DATE--- ---- --------------------------f BUILDING PERMIT ISSUED-----------•--- ----- -------------------------------------------------------------------- DATE------- ------ -------------------------------- Alterations ---- - - - - Alterations and/orrecommendations: I '--------------------••------------------------------ ---••------- --•----- ------------------ -------•-•:--------•--------------------------------- --•..----------•-------------------------------------------------------------------------------------•••-------------------•-----------------•-•----------------------- ---------------------------------.------- ----------------------I---- -- - --------------------------••-------------------•--•------------------------------------•-------•---------------- --•---------------- FINAL INSPECTION BY.-,---< ------------------------------------------- Date.... — ------ --------------�' SAN JOAQUIN LOCAL HEALTH DISTRICT 1 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street i 111 Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100