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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) - Date issued /ST pplica{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 madein compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION.: ---- t--------------------------------------f Owner's Name_14-AZ -•--- -- . F r'- ---=--'-------- Phone----••-----•-------•----------•-•--- � Address-- !-2 _ 13 Contractor's Name__ _ t --E-- =-E---- ----r- '-- --------- - '- �� ---�--------6-�---• ---•--••--------------------------------- Phone-------r�---�-��-�•EJ'r1- Installation will serve- `Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms ... Number of baths ._%_-Lot size .. ------- �`Q--------------__-_ Water Supply: Public system] Comm unity`"system'❑ Private ❑ Depth to Water Table _"__=___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ . Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [V Hardpan ❑ Previous Application Made: Yes ❑ No New Cons#ruction; Yes 2L 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__A/d!✓V,Distance from foundation_---_LJ_--_.-___ No:.of.com artments_..__�---E" .7�_ __________._Size____ _.__ -Li uid depth_--____,�_ ___._Capacity... F , Disposal Fie€d: ..Distance from nearest welf_ lh �'f]istance from foundatio�f_f___f__--.Distance to nearest lot linel_,1°_'--__ ® Number of.lines_____________ ____-_--_--_._--_Length of each line----____7Z'V__ ___`_k.Width of trench._-_ Z _J Type of filter ma#erial-,lam-_-_ --�J. c_Depth of filter material_-_-.4_.._-_I-_--Total length__---`.,i -------------------- Seepage Pit: Distance to nearest _----___.--ADistance from foundation-__—.'..___..t-_--.Distance to nea'rest'lot line-:.___°_---------- N ❑ umber of Material---------- Diameter-----------------------Depth--------- .--------------------- pits.--------------------Lining -- Cesspool- Distance from nearest well-----------------"Distance from foundation_____________ ___.Lining material--.--___---------_-_-___ El Size: Diameter--------------------------------------- -- ------ --------_---De th---------:-----------------_ -- -------------------Liquid Capacity_ __gals. Privy: Distance from neaeest well____________________ __________________________Distance from nearest building___---------------------------------------- 10-- ❑ ~ — "Distance to nearest lot I 4° - - ., _ :;-----------------Remodeling ---------------------------- ------•----•--------•----•--------------------_.. ---------------------=-------------- •--.------------•----------------------------------------------••--------•------=-----------•-------•------••------•----•-------------- --- -----•--------•-----------------------------------............------- •-----...-•---••---•------------------------------•--------------------------------------------------------------------------------------------------- tt ------•-----------•---------------------•----------------------------------•---•-----••-- --•------------ --------------------------------------------------•-----------=•-----•--_------------------------------------ I hereby certify-that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ,`and rules and regulations of the San Joaquin Local Health District. __(Owner and (Signed).-_ -'�-J-= -------I--------- ---------------------------- ( /or Contractor} B :. �'t'a�= - ------._ ` Title ( ) --------------- (Plot plan showing size of lot, location o�m rel ion to wells, buildings, atc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- DATE------_ _ __ REVIEWED BY `------------=----- --------------------------------------- DATE---- _^__ BUILDING PERMIT, ISSUED------- =--- .-----•------------------------------------------------------------- DATE-------•-----_---- Alterations and/or recommendations:-------------------------------- `--- --------------------------------•------------•-•----=--•--------...----•------•------•-----•-••------------_------- ------------------------------------ -------------------------••---'----------------------------------------------------------------------------------•--`---------------------------•---------------•----------------•----- -----•--------------•-----------------•------•------------•----------•------------------ --------------------------------------------•------•--------------------------•---•-----.----------••----•------------•------------ 3 ---------------------•--•.•-----....-- -----------'-- ....+._.----..-----------_-_--- ------------ -••-- -----•--•-••---•---•------------•--4---------------.....__---- •---_---------------------- .--.----- h FINAL -INSPECTION'- BY: r ==/------------------------------------------------------ Date.- =- l-_ ^� = 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 E5-9-2M Revised W-2100