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APPLICATION FOR SANITATION PERMIT Permit No. 1---------------- (Complete -----C---_`--:(Complete in Duplicate) > _ Date Issued /f -- - Applica-lion 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. .1 JOB ADDRESS AND LOCATION------YA—p 5Q._- Owner's Naw-_--- ,---- ---•-------_--------------- _-------------------------- - ----------------------- Phane_ __4_-j,7 .9 1 Address.------ �e'l.fhhp�---------------- Contractor's Name-------------------------- _ 'mak"-------------•------ --------------•--- ------------------------------------------- Phone---77----------•- -7_ -------- Installation will serve: Residence XL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units: _]-_-_ Number of bedrooms _Z-- Number of baths .------ Lot size ------- --____--_-______________ 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 E❑ Clay ❑ Adobe.0 Hardpan. ❑ Previous Application Made: Yes ❑ No;K New Construction: Yes$4 No ❑ 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----ho_.........Material_____ __ ________________ No: of compartments Size _-1-x �j~ Liquid�rd`epth ----Capacity---- ©©c # , Disposal Field: Distance from nearest well-T�'h- Distance4rom foundation__�_E_____________Distance to nearest lot line__3v-C______� -------- NumbNu'm'ber 30 Io io -Z .r er of lines---�-------'--------------- ---Length of each line 4D 3t___,l-/L---------Width of trench------------�'------------------- ' Type of filter material_-_45, ( 0 ____Depth of filter material--- ---------------Total length_---____)- - ________---_.._______-_ Seepage Pit: Distance to nearest well________ _------------ foundation---------..........Dista-rice to nearest lot line__-------________ ❑ t Number of pits----------------------Lining material--------_---------------Size; Diameter------------------------Depth--------------------_- ---------- Cesspool: Distance from nearest well-----------------Distance`from foundation._.-_._-.-___-_____Lining material -_.___----_----___._____________- - - -- Depth s, t : Liquid Capacity El Diameter-- -----=-------------------- ----------------------------gals. ' Privy: Distance from nearest well__________________---------------- -----------Distance fromnearest building___._--__---_----_____-__-____-________-_. ❑ Distance to nearest lot line-------------- - ---------------------------------------------------------------------- Remodeling and/or repairing (describe)------------------------------------------ - IT--•-•-----•---------------------------- ----- r - --------------------------------------- -----------------------------------------------------------------•------------------------------ •------------------------------------------------------- ! hereby certify'that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance State laws, and rules and regulations of the San Joaquin Local Health District. d(Si 9ner )- __ --- ----.,• ----- -•-=-------------- - ---------'----'-'-=----------- _ ---'----------------=--':-,------'-'------- -- --------------------(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). s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_______ __ __ _ ____ _____ _- _. __.-_a__ - --- /- • -- �-------------------- DATE-- -- -- --- ---• ----��---------- REVIEWED BY------------------------------------ t = ------------- DATE -- BUILDING PERMIT ISSUED ' = = - = ------------• DATE-------------------- Alterations -------------- 'Alterations and/or-recommendations:---'`------------------ ---•-- --- 1 --------------------------------------------------------------------------------------------------------- Y= - = ' ---------------- '-- -- ----- - ------ ------------ ----•---------------- FINAL INSPECTION BY:.- ' -------_- ---------LL---- -- ------------ 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 ; IRevised W-2100