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r _ APPLICATION FOR SANITATION PERMIT 'IPeiit� No. d i1 (Complete in Duplicate) Date Issued 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. 5/49. JOB ADDRESS AND LOCATION---------- ;7/0--- 0e-_ _177l-.�1,.✓ ------ -�----------------------------------- Owner's Name------------------------------------------449 ye. L-�?C e��.+' Phone-- ,114_7- /,.7-I__Q Address--------------------------•---------------------- = _r ? = n--------- Contractor's Name---------------------------- .'ss.�r -�. �� ' __;zU..... Phone------ QPM Installation will serve: Residence Apartment House Commercial Trailer Court Mot p ❑ ❑ ❑ el ❑ Other ❑ Number of living units: �-- Number of bedrooms _-_I'Number of baths ___ _ Lot size _� �___!_' _____C�__�_____________ Water Supply: Public system, Community system '❑ Private ❑ Depth to Water Table !__.-_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ 43 Previous Application Made: Yes ❑ No ❑ 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 well_" __ Distance from foundation__ _ Material___________ No. of compartments-_2 ------------------Size-4) _-_'�_ _ c O'Uquid depth-�1P_'` -----------Capacity--- --- 2-%, Disposal Field: Distance from nearest well- -____ Distance from foundation__60----_------Distance to nearest lot line______,0�x. ____ 19 Number of lines-__/_______�__�_« -Length of each line----1_QO----_______.Width of trench--_•�_V_'1________________ Type of filter material___ ___ _______ Depth of filter material__/_�___---__--_-_Total length__/�_Q'____.__ _______-____-_._ Seepage Pit: Distance to nearest well------_---------------Distance from foundation-----------.-------Distance to nearest lot line----------------- . ❑ Number of pits----------------------Lining material-----------------------Size, Diameter----_------------------.Depth--------------------------------- Cesspool: ----------------- _Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______--_______________- _________- ❑ Size: Diameter------ -----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ El __.__________ _---_____________-___-___.❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- • - • +• 1 f Remodeling and/fir repairing (describe).__ __ t # . t TM {=="_` - `_ _-° � `�`�" ---- ----------------------------------------- ---•-- - --------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------•---------------- I hereby certify that I have prepared this applicatio nd that the work will be done in accordance with San Joaquin County ordinances, State ws, and rules and regula ions of the San Joaquin .Local Health District. (Signed) --- Contractor) ------------------------------------------------- - ------ - BY ---7,, ---------------------•-------------------------------------------(Title)--� - + ------------------ (Plot pla s ing sloe of lot, lo inrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY L- ----------------------------------------------- -- DATE--------2- ! �7 ..�"- REVIEWED BY -------------- DATE----` r BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--- --- ---------------------------------------------------- Alterations and/or recommendations------------------------------- ----------------------------------------------------•-------------------•----------------... ------------------------------------------------------------------------------------- -----------------------------------------------------------------•-------------------------------------------------------------..._... -----•-------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------•------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------•----------•-------- ----------------------------------------------------------------- ------------ ------------------------ ---•-- ------------------ FINAL INSPECTION BY----------------- --------------------------------------------- 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 ES--9----2M 5-51 Revised W-2100