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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued -_17f SL 1 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. c JOB ADDRESS AND LOGPTION_____v___ __�1._:f ____ /' _ _� Owner's Name--------------•--------=r, 1�� _/_� 2f7° - ---------- Phone--------------------••-- --- - --------------------------------------------- Phone ------------------------------------------ --- � 1 f r Contractor's Name s� l —dr��/ �`, .. t ----------------- Phone-- Contractor's ` Installation will serve: Residence Apartment House ❑. -Commercial ❑ Trailer Court ❑ Mofel 1] Other ,❑ Number of living units: 1_ Number of bedrooms ___ Number of baths - .__ Lot size ------- � __________________ { Water Supply: Public system kI&Immunify system ❑ Private ❑ Depth to Water Tabled- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ''Hardpan ❑ Previous Application Made: Yes E] No m New Construction: Yes EA—:k- ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest we1Vf/Alt/Distance fro . foundation_/a----------Mat ri L__�� -- __-_`'�-_________-____. No. of com artments_ __ Size____..,_ ._tY_ � Liquid depth-_.___1_ ? Capacity Disposal Field: Distance from nearest weIW476VZ�Distance from foundation_ ----------Distance to nearest ]o ❑�� Number of lines_____ ___®_ --------I___ Length of each line----- ______________Width of trench_-_.s ------ ---------- TYpe of filter material_'_"_-_'___. ADepth of filter material_. _- ---------Total length__-------\_1 O Seepage Pit: Distance to nearest welL//� _-Distance from-,,��oundation__ .G__...____.pistance to nearest lot line--9-6-____. /Number of pits--. sO------__Lining material__jfj0At .Size: Diameter____ ---------Depth___-- _6�-/------------- Cesspool: _-________Cesspool: Distance from nearest well----------------Distance from foundation--_- ----------- _.Lining material-_---------------------------._______ ❑ Size: Diameter--------------------------------------Depth-----------------------------------------------:----Liquid Capacity,_------------------------gals. CA Privy: Distance from nearest well-------------------------------------------------Distance fromEnearest building------.-_-.______-______________________- ❑ Distance to nearest lot line----------------------------------------------------------- = "- 4----••--------------------•----•---------------------------- Remodeling and/or repairing (describe)___________________ ___ -� f -----•--------------------•--------------------------------•--------- -----------•-- •-•------------------•-------------------------------•----------•---•-----------•----------------------------------------------------- -•---------------------------------------- ----------•----------------------------------------------------------------•--------•- --------------------------------•-•---•-•-----•-----•----------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules an regulat• ns of the San Joaquin Local Health District. (Signed) ---- -- max (Own and/or Contractor) s By: - {„-------- ' t � ------------------------------ Title7.- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc„ can be placed on reverse side). 'FOR I3EPARTWENT llSE ONLY A APPLICATION ACCEPTED BY _- __,_ f DATE___- .. Rl»VIEWED BY ----------- ------------------ -------------- ---- DATE C>-------------- BUILDING PERMIT ISSUED----------- -------------------------------------- -------- DATE------ - ----------------------------------------------.fes------------------------------------------- Alterations and/or recommendations------------------- -- wns e- _ ---------------- ---•----•--•--.....---.------=------------------------ --------------------------------------.: -•-------------------- -----------------=`�----_-" '- ----------------------------------------------------------------------------------------------------- 14" ----------------------------------- i --------------------------------•----------------------------------- ------------------------------------------------------ ---------------------------------------------------------------------- i FINAL INSPECTION BY--------- ------------------------------------------------------ Date- ---------- - ----------- i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C•• Street "r^ Stockton, California Lodi, California Manteca, California Tracy, California i i ES-9-21A 8-51 Revised W-2100