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> x 5... ` �t APPLICATION FOR SANITATION PERMIT Permit No. .. __ ______ y (Complete in Duplicate) r Date Issued __�`f4 i 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. { \y -- - •-------------- ---------------------•--••-------`--•----------------------------------•---•------------ JOB ADDRESS AND LOCATION_ _ _ ,-__� � Owner's Name-------- - --- -•- ----- Phone------------------------------------ - --------------------------- I Address-------------------- _-- 7----&_ --- --._.._-..-------- --------- ------------ - - --- ------ -- Contractor's Name------ --- --- - -d--------— -------- -------- - --- ---- - ----------- Phone.___ Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ Number of living units: __ ___ Number of bedrooms -/�---- Number of baths ____ Lot size ---- .- a ____1___ --v-.---_ Water Supply: Public system -Community system ❑ Private ❑ Depth`to Water.Table -Fp ft. Character of soil to a depth of 3 feet: Sa -F] Gravel El -Sandy Loam ❑ Clay Loam E] Clay ❑ Adobe Hardpan El Previous Application Made: Yes o E] New Construction: Yes ❑ No ❑ `a 1' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o F -Se tic Ta Distance from nearesr well_________._.___Distance from foundation--- _e_..........Ma'te ial__ 4�/ �0_07 P ... No. of compartments-...�-.-------------Size---- - ----Liquid depth-_-- .- --Ca pacify �`-� Disposal Field: Distance from neares well-_ '----.._.Distance froni foundation---�Q____-._.Distance to nearest lot liin_�-0._.---.. Qr�r, Number of lines_-____ ..__ _____ Length of each line_____6-0-___-__-______.Width of trench___. __, _ .. ;f------------------- Type of filter material__ r_Depth of filter material.._.e__A?..__-_--Total length___.___f____ --------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__-____________ ❑ Number of pits------ -------------Lining material-------------------`---Sizer.Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation----- .___----------Lining'material________-_..____________.____._______- Pri ❑ Size: Diameter--------------------------------------Depth_ ___ ------- -------- - ---- Liquid,Ca acit _ ------------------ C.,; ; -- - vy: Distance from nearest well------ ____._._'--------------------------------Distance from nearest building...... _ . ❑ Distance fo nearest lot line- -------- ----------------------___j------------- ---------------------------------- :.. ---------- - -------- Remodelin and/or repairing describe :___._______"_f Z :__ l _______________:__-_______.____________________.-_-_____ _________-------.-_----_-_____-_-__----_____________-______________._______________.__-_-____ I hereby certify that I have prepared this application and that +he-work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg tions o the San V�6 uin Local Health Di t cf. (Signed)-- �f ----------- --/ — ( --- {Owner arto Contfactor EBY:. ��-------- car•• •------------------------------••-- • ---------------------(Title)---- .----- I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ' I R DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--------- - ------------------------- -------- DATE REVIEWEDBY------------------------------------ ----- -------------------------------------------------------------------------------- DATE---'---.--.-------------------------------------------------- BUILDING --BUILDING PERMIT ISSUED-------------------- --------------------------------------------------------------------------------- DATE--------------------- Alterations and/or recommendations:------ ------------------------------------------------------------------------------------------------------------- -----------------•-•-------------------------------------- -----------------------•--•-•---------------------- ---------___----------------------...........---------- - -------------------------- --------------------------------- - ------------------------------------------------------------------------------------------•----------------•---•-----------•-•-_ -•-------------------------------- •--------------------------- ----- • - --------------- 4 A FINAL INSPECTION BY------------- -------°�' •-- ------ =--------------------- 'Date l 11 1 SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21M 10-52 Revised W-2100