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5 APPLICATION FOR SANITATION PRtiIIT Permit No. . __ ..... 1 {Com lete in Du licat e P P } Date Issued __ /X......... A' Aplica{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 Ordin nce No. 549. JOB ADDRESS AND LOCATION------- / _ `---•-- -------------------------------------------------------------------------- Owner's Name r ='1j ----------- Phone /O .Z C� Address` �1------- ` '`', " .'Y ----------------------------------- - -------------------------- Contractor's Name..---- 46_ --------- `" Phone 7 .Z Installation will serve: Residence �4 Apartment-House{] -Commercial.j].-Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___ Number of bedrooms _uz-_ Number of baths f___ Lot size ---- Water Supply: Public system Community system ❑ Private.❑ .Depth to Water Table 4S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeo Hardpan ❑ Previous Application Made: Yes ❑ No New Construction:'Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - f4 r-1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5 ti nk: Distance from nearest well______.____+____ Distance from foundation-------------------Material_-------------------------------------_---------- No. of Compartments - '� ---Size-------- Liquid depth - Capacity Disposal Fiel Distance from nearest well1djO._ Distance from-foundation-----__/6__-*.___.Distance to nearest lot line___* .______ ® Number of lines-------- -----------------------Length of each line..-- -Q-"---_----_----Width of trench------- -��_��--------------- � Type of filter materiaI__S_r_/?PV'-k__Depth of filter material-t____ _�f__._Total length________---5/_Q_'________------------ P , Seepage Pit: Distance to nearest well_.ldd__._�____Distancee from foundation_•-..3_U.�.__.Distance to nearest lot line____%5.. .... Number of pits------ _______i-------Lining material__L-o�i+� -d4e-tL_Size: Diameter_____ Depth_____ _S___--________________ Cesspool- Distance from nearest well-----------------Distance from foundation!------------------Lining material_____._________________,__-__________. ❑ Size: Diameter----------------------------- --------Depth--- ------------------- Liquid Capacity g Privy: Distance from nearest well--------------------------------------------._--._Distance from nearest building-----------------------------------------_. ❑ Distance to nearest.lgt line--- --------------------------------+r---------------------= ------------------- -------------------------------------------------- J�l,(�yami,� .�� 1' •� � � D r Remod ling nd/or repairing describe :___tit�G�►.e4ts<.__ 11.. 'z-c �-: ----'-----------------------^' - �_ `_. x --------------------------------- ------- --- ------------------------------•---------- ---------------------------------------------- ---------------------------= - - -------------------------------------------------------------------- I hereby certify that I have prepared this ap"plicatio�4 at the wark will be done in accordance with San Joaquin County ordinances, State laws, and rules and egulations of the San Joaquin Local Health Djstrict. (Signed).......- .'�a.��----- '6 ------ •----P)�--(OwAier and/or Contractor By:..... �"--------------------------------•---------ITitl` -- --- --- ----- --- --------- - --------- - (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE/ONLY APPLICATION ACCEPTED BY---- - ------- --------- ------------'--- ?�' ------------------ --- DATE---z ---"---- ---------------- REVIEWEDBY-------------------------------------------------- -- ---------------------- -------------- ----------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE..--------- --------•----•----------------------------•----- Alterations and/or recommendations-------------------------------------- ----•------------------------------•• = -----------••---•---------•---•-----------------------------------------------------•-------------- -----------------------------------------------------------•---------------------------•----•------------•--------- -----•------------------•--------------------------------------------------------------------------------------------------------------------•----- --------------------------------------------------------------------.._. -----------------------------•--- --------------------------------------- ------------------------------------.._.----------------- ------------ �---�------�-�------•----------------------------------- U -� 1 - -------------------------------- Date----------------------------- FINAL INSPECTION BY------------- -- - -- ------------------------------------------•---• 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 Revised W-2100