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APPLICATION FOR SANITATION PERMIT Permit No. ------ • (Com tete in Du Duplicate)P� ) Date Issued ---- y9/} TA plica 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. 549. "� , �-----v ��— „ �y ---------- JOB ADDRESS AND LOCATION-----------------------------p I ------ ! l --- r+ Owners Name----- ily ff6d-------- -------------------------------------- -------------- Phone-----•------------------•-•-------- Address ------ - - --------••--•••------------------------------------------------------------------------------------------- -f7`E �------- ` Contractor's Name-------P��-----_••------- -• ----- - °-�-�- ---------------------------------------•- ------ Phone../?VO---(� Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: /_--. Number of bedrooms _,Number of baths ._/___ Lof,size __:__ N__ _f r _6____________________ Water Supply: Public system W Community system ❑ Private ❑ Depth to Water Table.5-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No A_ New Construction: Yes ❑ No 24— TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d I Septic Tank: Distance from nearest well-/!07 -r Distance from foundation__14-1_ ------Materiaf� -------- No. of compartments....... _ ------------- AX---N _ Liquid de th______6-0_____________Capacity------ Disposalfoundation Field: Distance from nearest well___4 Distance from foundation_.__f _ ___-Distance to nearest lot liner______ s, Number of lines ------------ . Length of each line______''' _______._.Width of trench-_�_ ® „ � T------------------ Type os filter ma teriaf___ �____-S•_£�1 Depth of filter mate ria l._-_�L _------Total length______ ____________________ f r + Seepage Pit: Distance to nearest wall____A/4 =Distance from foouund�a'tion___7Q__:-----Distance to nearest lot line_____^___ xNumber of pits--- Lining material__6_P o9 i3c i:-�Diameter-_--Z5!_*_-e le'-__ -------------- Cesspool: Deptn---- - ------------ m r Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_________.___._____.________________ ❑ Size: Diameter------- ------- ----------Depth--------------------- -----------------------------Liquid Capacity------- ---------------gals. Privy:l Distance from nearest well___-------_------------------------_-------------Distance from nearest building------------------------------------------ 9 ,J ❑ _ Distance to nearest lot line----------------------------------- ---------------------'-------••--•--------------- ---------•-------------------- -t, i Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------ ... ----------=---------------------------------------------------------------•-----------------------------------------------------------•----•------------------------------ I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. e (Signed) e / --- -- ___�Owner and/or Contractor) BY:-- -- -------------(Ttle)----� ------------------------- ---------------- _ -------- (Plot Olan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- -- -------- ----------------------------------------------- DATE----------- ---------- REVIEWEDBY---------------------- ----------- = DATE-------- - -----------•----------•------------ BUILDING PERMIT ISSUED------------- - - DATE-------------- ---- ' Alterations and/or recommendations______________________ __._ ____ ----- '--- ---- - ------ -- -- -.------------------------------------ -------•----------- a -------•---------- •--------------------------•---•---------------------------------------------------•-------------------------------------------•-•-----------------------------------------------------•----•----•-----•--- --------------------------- ---- --------------------- ------ ------ ---------------------------------------------------------------------------------------------------------------------------------•---------------- INSPECTION W BY:_ .:. --------:-------------------- Date.- FINAL :1_ - ------------------------------------------------------- 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 Revised W-2100