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� t - APPLICATION FOR SANITATION PERMIT ��4 Permit - � •� (Complete in Duplicate) U' Date Issued _ _.1__ • _ .. as .- D ^f v 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. `� JOB ADDRESS AND L TIONl�_T__ ___ ____, ------- ;f�4�----------- -------t. Owner's Name Rf - --------------_-------- -------------------- Phone Address-------- ., *----------- 7=-=-- ` ---------------- Contractor's Name----------------- -- -------------- -- Phone----------- ---- Installation will serve: Residence g- Apartment House ❑ Commercial ❑ Traile Court [-] Motel ❑ Other ❑ Number of livingunits: -------- Number of bedrooms _3-_- Nuri'ber of baths __ _ 'Cot size ----------- Water _____._Water Supply: Public system ❑ Community system ❑ Private ®''Depth to Water Table 17 ft. l/ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ['"Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ No M New Construction: Yes 9�] No ❑ ` TYPE OF-INSTALLATION AND-SPEC]FICATIONS:,, w. ;�— -- (No septic tank or cesspool permitted if public sewer is available within 200 fVt Septic Tank: Distance from nearest well____-�-----Distance frpm found ation____ _________Mater'1__.__C __._ - _ -__- ___:--..Liquid depth------.--------------Capacity_ No. of compartments--=--�------��----Size--- -�! �/� � --------�- .. Disposal Field: Distance from nearest well-S ._____Distance from `Foundation-----�,l_`__ Distance to nearest lot line �^ Number of lines______________ _�+". ----Length of each line___________-----_____ -- Width of trench___. ____._____ _ �,--- it - �---r--------- Type of filter material� __�_Depth of filter material__ ___=________Total length__________________ Seepage Pit: Distance to nearest-well_______________.____Distance from foundation--------------------Distance to nearest lot line_________________ v ❑ Number of pits----------------------Lining material-----_-----------------Size: Diameter-----------------------Depth-----------------.-------------- Cesspool: Distance from nearest well-----------------Distance from foundation_________________.Lining material___________________:_-_______________. ❑ Size: Diameter-------------------------------------- p ---_- ------- Det ---- - -- ... F'ivy_• .=} ___Distance:froni crest-well---------------__ _____ _____- __ _____Distance from nearest building___- ❑ Distance to nearest lot line--------------------------------------- Remodeling and/or repairing.(describe):--------------------------------------------------------------------------------------------------------------•-------------------------- ------------- -------•-----------•--------=------------------------------------------------------------------------- ---------------------------------•--------------------------------------------------------------------- -------- -------------------------------------------------- ----------------------------------•-- ---------------------------------------,.....-.--------------------------------•---------- ------- ---- - hereby certify that 1.have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations o. he San Joaquin Local Health District. z, l ;(Signed)---- -------------- i� ""_:= Y .1_ _ „---- (Owner and/�or Contra r] � By:-------------------------------------------------------------------------- "" -s--J-------------------------------(Title)---------- - - - - (Plot plan, showing size of lot, location of system in relation to wells,•buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -___ _ _ -- - `�--- -- `�f'~f-- � `" -- DATE------- -- -- - ---��_- � REVIEWEDBY = ----------------------- - --== ----- DATE--------------------------- ----------------------------=---- BUILDINGPERMIT ISSUED--------- -------------------=------------------------------------------------------------------- -- DATE---------------------------------------------------------- Alterationsand/or recommendations:--------------------------------------------- --------------------------------•-------------------------------------------------------------------------- --- ` --------------------------------- ---------------------------------------------------------------- ----------------------------------------- --------------------------------------------------------------------•---------- ------------------------------------------------------•-•------------------------------------------ -------- ---------------------------------=----------------------------------------------------------------------------- _________________________________________________________.-____..______________-[_/_�•____.�_--_____________p,__-____Y)__ __--{ys_---.___F_ -_-------------------------------------------------------------- FINAL INSPECTION BY-------- ---- - ------- ------------0----------------------------------------------------------------- JOAQ 1NN LOCAL LTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street , Stockton, California Lodi, California Manteca, California Tracy, California f ES-9-2M 8-51 Revised W-2100 _