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APPLICATION FOR SANITATION PERMIT Peit N . ........... ---- (Complete in Duplicate) T ate 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 LOCATION-___--__�AM–' _--.W; . � N- V --,_:,.-. Owner's Name---------/=# -------•---------------------------- ----------- --------- ------ Phone ! _+ 1 { Address ----- :----------piren� ' —0-----•---�sse �.JE----------------•------------•---------------------------------------- ---------------------- Contractor's Name---------------- -------------------------------------- ------------------------------------------- Phone.---�---�--��+_---•� Installation will serve: :Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ r Number of living units: __. __ Number of bedrooms t--- Number of baths ._ ._. Lot size ------ a___-__-------------- f{ Water Supply: Publiclsystem ❑ Community system ❑ Private I% 'Depth to Water Table ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe; Hardpan ❑ Previous Application Made: Yes 0 No x 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 wek-GA...._Distance from foundation__nz 7--------Material---- -.---Li uid de th__�",. ..---:__.Ca acit Qp-�- , (� No. 'of compartments___,� �_____..____Size� �� __ q R '- - pacify-- Disposal Field: Distance from nearest well_ D_-__- Distance from f undati n___ ...-_----Distance to nearest lot line_-.-._4 S4__ Number of lines-----r!--------_---------------------Length of each line---- iP*_.------------Width of trench__.2.4"-------_-_-___-,-_ Type of filter material--1----------___________Depth of filter material---------__-------------Total length-----------------(_0____-_.-_-;-- Seepage Pit: Distance to nearest well_.1��._�"Distance from foundation___ 151:__-----.Distance to nearest lot line----- y Number of pits.--I________________Lining mate ria,l �___Size: _.. Diameter_ _3�� _ .___-__ Depth_. '__.______________. Cesspool: Distance from nearest well----------------- from foundation----- ---------------Lining material------------------------ -- ❑171 Size: Diameter--- ------ ------------r-----------Depth---- ------------ ---------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------- Distance 'from nearest building---_--_---.-_-----_-_---__-__---_--._. ❑ Distance to nearest lot Zine___________________________ ---------------:--.:7------------------r-_7 Remodeling and/or repairing (describe):,-_---------------------------------------------••----•---..--------------------------------•--•-••--------------------•-------- --------------------- ---------------------------------- •--------- _----•--------- .. '-------•-------------------------------•----------------------------------------------------------------------------------------------•--------•----— a I hereby c t y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Staya ws, an rule and regulations of +he San Joaquin Local Health District. [Signed]------------ - ------------------- ------�---------- -__ �'GR.�-x-----------------------------._Title__ �R- � --�-mss Contractor] By:. ---------------- ---------- { ] - . (Plot plan: showing size of lot, location of system n rel.+ion to wells, uildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------ DATE--------------- ------- -- --- REVIEWEDBY----------------------------------- -----------------1 - — ------------------------------------------ DATE----------------- --- ---- BUILDING PERMIT ISSUED-------------------------------------------------------------•---------------------------------------- DATE------------------------ ------------------------------------ Alterations and/or recommendations----------- -------------- ------------- ----------------------------------------•--------•-----------------------------------------------•------------- ----------------------------- ---- --- _______________________________________________'_-_-___-_-.___---.-____--.--...._----..-_---.-..-..--_-_-_-.__---_---------__._-_-_--_-_-_-_--_-----_-_-_-_--___-.-.-...--------_------------__-_.____----___._---_-----___--__ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---- ---------------------------------------•-------------------- FINAL INSPECTION BY:._____. .r �-�` ----------.- Date............... " - -----�" ---._._------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100