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t�. APPLICATION FOR SANITATION PERMIT Permit No. - .. _ ..___ " (Complete in Duplicate) ' _ Date Issuer) Application is ereby made to the San Joaquin Local Health District for a permit to construct and install the jrork herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ ��------- ;: ' ' .*[- r "a�' CY►�41!,=:__ - ` f ..... r - --------- `G-f.-71 .�- a-le---Is------ ----------------------------------------' Phone---------------- - 61L4 -r Owner's Name--------------------- - �l�,�. _ Address----------------------------- ' �'t r' i Contractor's Name--------------------------- ---------------------------------------------------------------------------------------------- ------ Phone----------------------------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --_ Number of bedrooms .-/... Number of baths __ _- Lot size _ e s��__A _________________________ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,®_ Hardpan ❑ Previous Application Made: Yes ❑ No IN New Construction: Yes [❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewers available within 200 feet.) Septic Tank: Distance from nearest well__ OO Distance from foundation,.---Al---------Material--- /// �J No. of compartments-------A-______________size----7-X_V_XA-----Liquid depth------ _._------.-----Capacity__.. Disposal Field: Distance from nearest well--63�' _Distance from foundation---..Z.0-.-_-__Distance to nearest lot line____)-�-0,._. i �. J Number of lines------ /__ -- Length of each line------_-P1� Width of trench-----el.$/.._._________-_-- Type of filter material --_Depth of filter material______ _S_"..._Total length--------- �_._____-__-____...._ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_.-....._-..__..- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---------------.-----_Depth----------------_---------------- O Cesspool: Distance from nearest well-_____________.._Distance from foundation--------------------Lining material..-.-___..___.-.....__._____....._._.. ❑ Size: Diameter------------------------------------Depth------ ----------------------- ---------------------Liquid Capacity----------------------------gals, vi Privy: Distance from nearest well-_____............................______..__-.-Dstance from nearest building----------------..__-__-__------_---..._-- ❑ Distance to nearest lot line----------------------------------------------- ------------------------------- - Remodeling and/or repairing (describe);----------------------------------------------------------------------------------- -------------------------------------------- ---•-- ------- ----------------------------------------------------------------------------------------------------------------------------•-----------------------------------------------------------••---------------------------------- - - --------------------------------------•------------------•---------------------------- -------•-•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,,.Sfate laws, and rules and regulations of the San Joaquin Local Health District. p � r F (Signed)--- t f /' yJ. xl =� t? (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,p AR7ME T USE 2NLY APPLICATION ACCEPTED BY---- -' `... -r �-' _- DATE------// REVIEWEDBY-------------------------------- ------------------------------------------------------------------------- ------------------ DATE----------------------- BUILDING PERMIT ISSUED-------- ----------------------------- --------------------------------------------------------------- DATE Alterations and/or recommendations-------------------------------------- =--------------------------------------------------- -------------------- --------------------- -------•-------------------------------------------------- --------- r h {'T.-.... Q. .................. t✓N C r�C 3}e —1 ,y r w '�? �----- ----- V y�t/ 7e-V t..fLt" .� .1.. .� ' VR !R!.� _ SAA Y�C� www[ 1/jL Him61*4 X.s .sj� _ _ �1 k f C 4t]i_ 4................. 1--.. #R- . ------__. __ ,� .P .' d w r , � /lhLl �6( wr/lS /Cyr), X30 J FINAL INSPECTION - - Date. `"P p ` ---------------------- 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 8-51 Revised W-2100