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PPLICATION FOR SANITATION PERMIT Permit No.3.- .-�_ 1 (Complete in Duplicate) /1 L Date Issued ----_I�- /6_� 'k Application is hereby made to the San J )a uin Local Health District for a permit to construct and install the work herein//described. This application is made in compliance wit "County Ordinance No. 549, JOB ADDRESS AND LOCATION ' ,. -t ----------------------------------------------------- r-. Owner's Name----------------------------------------- -------- --------------------- - +. .^"-----------•_----------------- Phone----'-'- -------- --------------- Address---------------- ---- --------Address--------------= ------------ -- -�r"=`---�'`--------- ---------------------- ------------------------------------------------......----------------------•-------- % Contractor's Name--------------•---------------------- r ,..------------------ Phone �� Installation will serve: Residence 2!k_Apartment House El Commercial E] Trailer Court -] /Motel [:] Other ❑ Number of living units:---/--- Number of bedrooms .3_ Number of baths _/... Lot size Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes Hardpan ❑ Previous Application Made: Yes ❑ No , New Construction: Yes ❑ No E] � ,.+.. Q--�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} Se tic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------.____..__----------.._...- . No. of compartments-------------------- Size--------------------- ---------Liquid depth--------------------------Capacity--•----------- � f Disposal Field: Distance from nearest well_-Nn,,--._Distance from foundation...jQ-f----.-.Distance to nearest lot line.__-4---------- ® ' Number of lines---/................... ........Length of each line__ --------Width of trench-------- ---�- ----------- ., oType f filter material-- !.jA—__k__Depfh of filter material----------) ......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---------- .-.-_-.Lining material------------------------------------- ❑ Size: Diameter------ -------- -------------------Depth--------------------- ----------------=------------Liquid Capacity----------------------------gals. Privy: Distance from nearest'wel----------------------------------------------- from nearest building--.=.-.-...._-._..____------__---------- tit ❑ Distance to nearest lot line-- -------------------------- -- ---- Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------=-------------------------------------------------------------------•-----------------------------------•--------------------------------------------------------------------------- ------- }--- ---------------------------------I----------•---- ..---------------•------------•-------------------...--------------------•-•------------------------------------------------------------------------- ------------------- --------------------------E =---------------�-------------------------------------------•--•--------------...------------•--------...-------------------------------------------------------- I hereby certify that.l!hay„ prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a-n�f-rules and regul tions of the San'Joaquin Local Health District, (Signed)--- > ---------------------------------- h ------------------------ ,Owner and�or�Contractor) �"'.�A; `- / i. Title .C�+..r---------------------`=,---------- Y: --------------------------------------- ----------------- ----------------- ( } p_ (Plot plan,.showing size of lot, location of system in relation to�w,ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- -- ---------- ..�•-... ------------------ DATE------------I t �7.�--------------------- REVIEWEDBY--------------------------------------------------------- ------ ------------------------------------------ DATE BUILDING PERMIT ISSUED----------------------------------- ------------- -------•----------- DATE Alterationsand/or.recommendations:----------------------------------------------------------------------------------------------•------•----•--•-----------------•-•--------•------------------- -------•-------------------------------------------•------------------ -------------- ------------------------------------------ ---------•--••-------•- .......------------------------------------------------------------ ------------------••------...._.---------------..-•----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ----------•--••-•----------••- --------------------------- ------------------------------- --------------------------------------------------------- ak '. r _ r FINAL INSPECTION BY:.. ± Date.... J 14 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 10-52 Revised W-2100