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� Permit No.'.--- ---1�b APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) V Date Issued ------ ----- S pplication is hereby made to the San Joaquin Local Health District for a permit to co s r ct and install thework ereirt described. This application is made in compliance with County Ordinance No. 549. �� qq 4 ' r -S "�'`" - ---------------------------- JOB ADDRESS AND LOCATION-------------- ?----- e��" s Owner's Name----------------------------------------------/—A 12 r --•--- '--- -----------t? ----------- ------ Phone--.. --Oo 0-------- Address-------------------------------------------------------- 7 ------- ------------------------------------------------------------------------------•-----------•------------------------- Contractor's Name--------•---------------------- -r------ ' -s.------------------------------------------------ -- --Q- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Q '- - /tea Number of living units: __/_. Number of bedrooms _ Number of baths _-_I_• Lot size _ --- ----.-- Water Supply: Public system-[ Community system ❑ Private K Depth to Wafter Table�3�_ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No;E� New Construction: Yes ❑ No ❑ �u �.#Q•c- ��- -'� �. TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se 'c Tank: Distance from nearest well-----------------Distance from foundstion--------------------Materia---____----____-----..--__-------__..--------_-. k'; a.-� No. of compartments------- ------------------Size--------------------- - -------Liquid depth--------------------------Capacity----------------------- Dis;'osal F• Id:, Distance from nearest well from foundation-------------------- to nearest lot line----------------- Number of lines---------------------- ------------Length of each line----------------- Width of trench. _`--- ------------- Type of filter material-------------------_----Depth of filter material-------- ---------Total length-------------__----.---_-------_.-------.- Seepage Pit: Distance to nearest we11 00------___--Distance from foundation--- _ -----. .Distance to nearest lot line----------------- Number of pits----- --------------Lining material ------Size: Diameter--Q a ---- Deptn___��.....: _ ---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------_---__-----._-.-----_____---.--. ❑ Size: Diameter-------------------- -----Dept-h-------------------------------------------------_.Liquid Capacity- --------------------------gals. ------------ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- • ❑ Distance to nearest lot line----------------------------------------- -------------------------=----------------------------------- Remodeling and/or repairing (describe):------------------------------------- - - - -----------------•-------------------•------------------------------------------------ -- - - --- - - - --------- ---- ----------- --------- -- --- ------ q Y I hereby certify tha� ve prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and r les and regulations. o the San Joaquin Local Health District. (Signed)------------------------ -- .wZ � Z° A--------- --------------------------------------------( rte Contractor) 6 .� A .� (Title)- t2l� f (Plot plan, showing size of lot, location of system in relation�o wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------------------- DATE-. --------------------------------------- -------- DATE---- ------------------------------------------------ REVIEWED BY------------------------- --------- ---- - ---------------------------- - ------ -------- ------------------ - �� BUILDING PERMIT ISSUED - -------- --- DATE - ---------------- Alterations and/or recommendations--------------------- ------------------------- ---------------------------------- ------------- --------------------------------------------------------------------------------------------------------------------------•:-------- .. ---------- ------------------------------------------------------------------------------------- -------- --------------------------------- ---:---------- ----------------------------------------------------------- ----------- FINAL INSPECTION BY:-------ll' � --------------- Date---------------� .- 2-6 -------------- -- -- -- - -- -- 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-4--2M 10-52 Revised W-2100