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.� APPLICATION FOR SANITATION PERMIT Permit No. -- /..3- (Complete in'Duplicate) r � Date Issued Applic&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 Ordinance No. �54�9. JOB ADDRESS AN ATION -a--- ---~----S--_-- 1'-y------Z -------------------------------- ---------------------------------------- ATION Name--- �-. - - - ------ -------------------------------------- Phone------ --- - _ I`I -_. S.A - t Address r -----•------=------------------------•------------------------ --•-----...---•- +r Contractor's Name ..�_. ----- -- - - ------••------------- ------------------ ---------------------------- --------------------------------- Phone----------------------------------- 1 Installation will serve: Residence 5K,,Aparfment House ❑ Commercial ❑ Trailer-,Court ❑ Motel ❑ Other ❑ Number of livingunits: _- ---- Number of bedrooms _--�/ Number of baths -)---_ Lot size _ _ - r ------ 1--�� Y-1--- Water -•- -------------------- 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 ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �} Se ti Tank: Distance from nearest well_hj&Aj-lZDistance from foundation---10--------- Material_- �No, of compartments-=--- i -- -----------Size-- -- -- ---= -�---Liquid depth----- --------------Capacty--_- -- Q-- _.. . Disposal Field: Distance from nearest weIL.q_0_ 1t Distance from foundati n-_-1-0--_-----.Distance to nearest lot line -------- Number of lines---- .1----------------------- ngth f each line----- -Q-- "--__-'- Width of trench..--- -____-- "\ Type of filter material__S�_F -_9� 4U6i g - clter material length-----)-. , Seepage Pit: Distarice'fo nearest;'well_'__---__--_-----_-_Distance from foundation_-'................Distance to nearest lot line--___------_----_ ❑ Number of pits-------F.-:. -:--c Lining material-------------`'--------Si e: Diameter-----------------------Depth--------------------- -------- Y' ---- p i Cess ool: Distance from nearest well from foundation.---_.---__--. ;.--_lining material___-.--____-____--.----.-_---.-----_ ❑ Size: Diameter--- I-----------------------------Depth------- ----= �-------- -R..."".---Liquid Capacity----------------------- -gals. Privy: Distance from nearest well---------------------------------- -------------Distance from nearest building 5 ------------ DistanceV ❑ to nearest lot line--_-_-------------- Remodeling and/or repairing {describe):------------------------- ----------------------•------ -------------- ---------•----- -------•-------------------------- -----------------------------------------I---------------- --•-----•-------------•----•--------•--------••----------------------•---------------•----- ------------------------------------•-------------------- •=-------------------------••------•-------------------------------- -------------------------------------.--.-_-_--------.__...._--__--_--______._-____-______--._-____--._._-.' --.____.--__-_-----_--.--..____--.-_ --- ' -----•----------------------------------------- --------------------------•--------------------------------------------------------------------------------------------------------•-•--•------------------------------------- 1'hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules V.d regulations of the San Joaquin Local Health District. Signed)..- r�r - ---------------•----------------------------------•----------- Owner and/or Contractor -By:------------------------------------------------- ---------------------------------------------------------------(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 APPLICATIONACCEPTED BY--------------------------- ----- ------------ - ----------------------------------------- DATE-------------------------------------------------------------- REVIEWEDBY------------------------------------------------ ------ ---------------------------------------I------------------------ DATE- ------ -- BUILDING PERMIT ISSUED------------------------------ ------ -- -------------------------------------------------------._ DATE-- - ------- ----- Alterations and/or recommendations: -`-----------------••---------------------------_---------------•-----•----------- ------ ------• ------ ---------------------------------I------------------------------------------- ------ -------------- ------------------------• -------------------.-----•-••---------•---------------•---- -------------------•--------------•-•-•-•----•------------------------------------_--.--------------- ---------------------------------------- ------------------------------ --- •---------•--------••----------------------•------------------ •------------------------------------------------------------------------------------------------ ---------------------•-•----------------------------__---------------- ---------------------------------------- -' ----------------------------------------------------••--------- -------- FINAL INSPECTION BY: Date-.. -. / r .. SAN JOAQUIN LOCAL HEALTH DISTRICT X130 South American Street 300 Wes+ Oak Street 132 Sycamore Street era North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Ravised W-2100