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It 1 r ,V/ APPLICATION FOR SANITATION PERMIT Permit No. .�`-_ __�� (Complete in Duplicate) Date Issued __�6.- -_S�• Application is hereby made to fhe 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 LOCATION------ ----- ------ -------1 --- ,�. rr- - Owner's Name-•---------------------- Address ' �'.--c�---------� .+-i.�CL...---------------- -------------------------- •-------------.--- Contractor's Name---------------- ------ -------- --------•--- --------------------------•---•---- ------------------- Phone------ -`-�`--4/V-XP�`------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ___YNumber of baths __/-__ Lot size __6.©_� Q-------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay [] Adobe[ Hardpan ❑ Previous Application Made: Yes ❑ Na ❑ New Construction: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 66sWa� Fi ic Ta -� Distance from nearest well-_-________..__Distance from foundation--------------------Material------ _ ------__________-_ _____-___-----___.____. r+. f No. of compartments________------------------Size--------------------------------Liuid depth---------- --------- Capacity Id: N Distance from nearest well_-__._._.____-_Distance from foundation____________________Distance to nearest lot line________-___-___. �'+`" Number of lines ------------ -----Length of each line---------------------------.-.Width of french----------------------------------- Type of filter material__________ __ ______ Depth of filter material-------------- - --_Total length_______-_--_______._________-____-__� Seepage Pit: Distance to nearest ell-- _Distanc fro fo dation__ _�S-._._.___.Dista ce to nearest lot line_____ ��rr11�� Number of pits_______ __________Lining material_�f 'L Si,e: Diameter____ ��.....Depth__.Z_� -----__...___- 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------------------------------------------ E-1 ___._._________________---___-___._ .❑ Distance to nearest lot line Remodeling and/or repairing (describe):-------------- ------------------------------------- --------------------------------------- -------------------•----- ••------•----------------- --------------------------------------•-•-----------------•---...--------------------------------------------------------------------------------------------------------------------------•--------- -------------------- -----------------------------------------------------•------- --------------------------------------------------------------------------------------------------------------------------•--------------------------------- I hereby ce that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat la s, and rul . and r�ulations of the San Joaquin Local Health District. �. IrA (Signed)------------ 4V. -- ----- - -C�---- --- ----------- Contractor) Cont ar B :----------- "' Y ----------------- -------------;�dii --------------------(Title)--- - !/Tj ff..�---------- (plot plan, showing size of lot, location of syste relation to wells, gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- --------- ----------------- --------------------------------------- DATE----------- REVIEWEDBY------------------------------------------ ----------------------------------------------------------------------- -------- DATE---------- • BUILDING PERMIT ISSUED--------------------f------------------------------------------------------------- ---------------- DATE. Alterations and/or recommendations:-------- ----- --------------------------- ----------- --------------------------------------------------------------------------------------------------------------•-----------------------------•-----------------------------------------------------------------•-------------- ---------------------------------- --•-------------------•----------------------------------------------------------------------------------------------------- ------------------------------------------------------------ -----•---------------------------------------•-------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------•---------------- ------ • ---------------------------------------------------------------�f -------------------------------------------- g FINAL INSPECTION BY:---------------�'�1 7�� ----------------- Date---------------------/ 1 }fr 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 4 ES-9-2M 10.52 Revised W-2100 "&'