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- APPLICATION FOR SANITATION PERMIT Permit No. _��__ ':_ (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. 549.. JOB ADDRESS AND LOCATION /V.54 �Owner's Name. 1R a , 7 {r -A--- ------ -------------------------------------------- Phone------------------------------------ Address--------------------------------------------------------- r' .... Contractor's Name------ ---•---• ------------------•-•---------------------••------- ---•-•---------------------------------------------------------------..-_ Phone---------------------------------- Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___L Number of bedrooms J._- Number of baths__._-__ Lot size ---- _d.___-_ '14d ________________ 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 ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ t 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--------------------------Size------------------------ ------Liquid depth--------------------------Capacity-------------------- ---11� Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.____._______... ❑ Number of lines----------------------.------------Length of each line-------------------.---------.Width of french---.---------------.--.------------ 0 Type of filter material_________________________Depth of filter material---------------------_,Total length________________________._____-_--.__ Seepage Pit: Distance to nearest well_____-----------------Distance from foundation--------------------Distance to nearest lot line-----------------INN ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter-----------------------Depth------------------------------- -_-Distance from foundation._.. ._ . Cesspool: Distance from near st ;e�l___,�t f� __.Lining material.___:__. __ "____.____,_. Size: Diameter___ _'J____ __�� -�------Depth----------�- ------------ ---------------------Liquid Capacity....Trd-----------gals. Privy: Distance from nearest well ________________________________________________Distanceff om nearest building---------- __._____._________________._. ❑ Distance to nearest loft line__________________________ -- Remodeling and/or repairing (describe):---------C - ' w 1 /1 �s_S ___ Z9-J ________4__e.._}_ _ � ______ "f .......�- - �►' t •-•--•-•-•--•-------------------------•-----------•---------------- -----•----- 4 1 f 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. t (Signed)--____ ----- -------- ------ ------ a-------- (Owner and/or Contractor) - - ------ -- gY' - :-- (rte) (Plot plan, showing size of lot, location of system elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY----- --------------------------------------= DATE - S s- REVIEWEDBY ---------- ------------------------------------------- --------- DATE---N---------------•------ -----•--- BUILDING PERMIT ISSUED-------------------------------------------------------------------------- --------------------------- DATE--- Alterations or reco and 'mendations___________ _______.___.._..__._______._____ �11, v / --- --------------—---- ---- -------- - -•---------- :: -- ------------------- ---------------------------- --------------•----------------------------------•----------------------------------------------- 1 ---- --- ------ --- - ----------------------------- I 1 FINAL INSPECTION BY------------------ ------------------------------------•----- Date---------------------------------------------------------------------------- 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 Remised W-2100