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APPLICATION FOR SANITATION PERMIT Permit No. 'rI (Complete in Duplicate) Date Issued __!_0 _'� D3 S.- b rao-•-r r� Application is hereby made to the San Joaquin Local Health District for a permit to construct and i stall the work herein described. This application is made in to with County Ordinance No. 549. �� u p 1,rt rte-" 2- C nJ- L_0-,Af.4 )Q . JOB ADDRESS AND LOCATION---._._-_ '��G___a/-____--_____ ,/___ -•--__ - __ -------- Owner's Name 6-W----- f -t-r -------- ------- ------------------------------ - ----- Phone-- �------- 9-� -�'r7-- 7 Address.. � 1-------� 1'J J---�t, Contractor's Name--------------- Phone----y-'_9 .? 0 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E]Number of living units: __j__ Number of bedrooms __/__ Number of baths --4- Lot size _l __ °�ts x___ ___ _ ______________________ Water Supply: Public system ❑ Community system fl Private ET/Depth to Water Table 'e�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam eClay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [?re New Construction: Yes Q♦ No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tek: /Distance from neare well_____ Distance f m foundation_____.)' ____ aterial-------------------------- __________________ ---- --- --- ---- A . o. ---- -- ae -- -------------- iqui __Ca aci SD Dis osal,Field Distance from earest well___ Dis nce from foundation___ __ ________Distance to neare of line__ ©.... 5 umb ------------------ g oof ach"line------- ---- ------------- Type of f ilfer material___ _ _ ___________Depth of filter material------- - ----- Total length--- ------------------------------ Seepage: Pit: Distance to nearest well---------------------- from foundation_______-----------Distance to nearest lot line_________._- -.. ` ❑ Number of pits----------------------Lininterial-----------------------Size: Diameter-----------------------Dept h-__`_-------------Q---- Cesspool,: Distance from near t w II__ __�____ -Distance ro foundation___�j__'a----.Lining m�terial___r--�__w______._ Size: Diameter._---- -� -----------Depth---(_9 ----------------------------------Liquid Capacity-------•--------------------gals. Privy: -Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line------------------------------------------------------------------------------------------------- --------------------•--------------------- Remodeling and/or repairing (describe)-----------------------------------------------------------------------•--------=------- ------------ ------------------------------------------ �. ---------------------------------------------------------------------------------------------------- ------------------------------------------------------------'-----------•------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and ules and regulations of the San Joaquin Local Health District. 1 (Signed) L ----------------------------------------•------------------------------------------------(Owner and/or Contractor) 1 By:-------------------------------------------------------------------------------------------------------------------------------------(Title)--:--------------------------------------------:nt� (Plot plain, 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 ^ DATE r� REVIEWEDBY---------------------- --- ---- ------------------------------------------------------------------------------------ DATE------------------------- ----------- ------------ BUILDING PERMIT ISSU£D------------------------------------------------------------•----------------------------------------- DATE----------------------- Alterations and/or recommendations:---------------------------------------------------------------------------------------------- ------------------•---•----------------------------------- - - ------------------------ -------------- f --------------------------------------------- - -- �P )IT-1c;- �. �r �' '`� ---'--=--------k------------•- c ^ 4- ---�-s----a e'er------pec--1 1--------- Ie---�--tf----- 4 y 0--k,•-�-------------------------------------------------------------- -------------------------------------------------------------------- ------------------------------------------ - ---------- FINAL INSPECTION may_ --------------------------------- Date------ ------------I ---------•--- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r Stockton, California Lodi, California Manteca, California Tracy, California ES-1-2M 8.51 Revised W-2100