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�` ;06, �� APPLICATION FOR SANITATION PERMIT Permit Noe • �i (Complete in Duplicate) � y Date Issued --7 Apphcafion 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. �u JOB ADDRESS AND LOCATION___.____ _Q_ � =�' - -- .�..� ----- ------- Owner's Name---- ---------,- - s hof Phone_--- Address -------Phon------------------------- - - ---------------------�----- ---------[------ � Contractor's Name_-------------•j,g...... z7 _--- -------- - -•---- - - - e_--,�=-- aof Installation will serve: Reside�i nce ❑ Apartment House E] Commercial ❑ Trailer Court [-IMotel E] Other �G Number of living units: ________ Number of.bedrooms ________ Number of baths ____ Lot size ----------------------- Water Supply: Public sysfem K Community system ❑ Private ❑ Depth to Water Table Qft. Character of soil to a depth of 3 feet: Sand C7 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ Previous Application Made: Yes ❑ No,Jd- New Construction: YesX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if publics wer is available within 200 feet.) Septic Tank: D;stance from nearest well- - --------Distance from _ - fou--n-d-a_t-'io" n,/-'-------_Material---- m arfinen+s___ ________________ quid depth------��_'�------Capacity-ARO Q ---------- Disposal ----_----_-_-_-_---_ Dis osal Field: Distance from - nearest well from foundation_AO-________--Distance fo nearest lot line--- t Number of lines.________f__ ______ ______ Length of each line__� Q --------.Width of trench___- �� __- ,,��pp-,,,,,, '/ _____ yp Iter material__ 4 ___ q-__Depth of filter material___�_�- ______Total length___�D--________________--------- Seepage __ See a e Pit: Distance t fam- e o i p g o nearest weii__ ---Distance from fo ndation___ _�-_.______.Qis#ante to nearest lot Number of pits______-__/________Lining material_0C i ---Size: Diameter__JV s Depth ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.__._____________-Lining material_________-___________________.__-.. ID eter--------------------------------------Depth--------------- ---------Liquid Capacity----------------------------gals. Size: Diem ----•---------------------- Priv Distance from nearest well______________________________________.____-____Distance from nearest building_____------______-_______-_ Y• I� ❑ Disfance 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, St to ws and rates and regulations of the Sart Joaquin Local Health District. I 4r ,,(Signed) ' " ` S F ' r.• '-"-7 C---'-------------------------------------( r Contractor) � �, By:--------- '_'`'�° W {Title) R""-�` (Plot plan, sho ' g size of lot, Ilocation'of sys m in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ ---- -------------------------------.----------- ---------- , ------- DATE_`u REVIEWEDBY ------- --- - --- ------------------------------------------------------------------------ DATE BUIL ---------•---------------------- Alterations and PERMIT ISSUED----------------------- -- ------------------ -- --------------------------------------- DATE----------�'- ---------------------------------------------- d/or recommendations:---------------------- -----if----------------------------------------------------------------------------------- ----------------------------- ---------------•---------- Ip-------------------------------------- �r i-JS r :__� ` ' + �" FINAL INSPECTION BYate-- ----------------�---- ----------------- i' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I� 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton; California ii Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100 Iw 4