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H -, APPLICATION FOR SANITATION PERMIT Permif No. (Complete in Duplicate) - „� "_ .Date Issued i Applica*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. f JOB ADDRESS AND LOCATIOON-----------------_..__ �__---- - !f/ �I h ------------------------ -------------------------------------- e - Owner's Name---------------- ----- : == Phone --------------- Address -----•—•----------------4- ie4v-.-C----------------------------------------------------- ------ iContractor's Name. >� -`-------------------------------=-------------------- Phone----------------------------------- ' Installation will serve: .Residence Apartmenf House E] Commercial-❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --1.--_ ber of bedrooms _yNumber of baths -1..... Lot size ------------ ----------5"_X 4�� ----------------------------- Wafer Supply: Public system - Community system+❑".Private ❑ Depth to Water Table -------- ----- ft. Character of soil to a depth of 3 feet 4Sand Gravel ❑i Sandy Loam Clay Loam ElClay n Adobe �Eardpan ❑ Previous Application Made:1iYes�lo New Construction: Yes [ No El TYPE OF INSTALLATION AND SPECIFICATIONS: I fir. 4 }(No septic tank or cesspool permitted if public sewer is available within 200 feet.) r 1,7""' r - 1.� Se is ank: Distance from-nearest well-12— -__Distance from founds ion_ _ Material- - -_e ---r r Liquid depth-------- d No. of compartments---------�---�� --Size----...�'�� ---- ----- - Capacity-----�----�-•--- 11 � _ — , Di o al Field: Disfance:from nearest well_ ------ ---_-Distance from foundation__.1d---.----.Distance to nearest lot line 'F Number"'fof lines......... -----------41ti Length of each line-------------- ----- --{----Width of french-------- Type ofilter material- ------Depth --------•--- of filter materral_-__-_��--_�-_--Total length------------ Seepage Pit: Distance.lfo nearest well-_-,----------------Distance from foundation---___- -_.'-.-_.Distance to nearest lot line--.----r---__---_ v1 ❑ Number of pits-----f------- --Lining material-----------------------Size: Diameter-----------------------.Depth--------- ----- ---- --------------- Cesspool: Distance from nearest well------------ __Distance from foundation.--_.-_---i Lining material----------------_----.--__:---- _ El Size: Diameter---------=-------- -------------------Dept h-------------------_--.......-.------------------Liquid Capacity-----------------------------gals. Priv 3 ` ..s r � Privy: Distance. rem nearest ��efl----------------------------------------- -----Distance from nearest building---------------------------------------- El -:-----------------------•----_------❑ Disfancel}to nearest loft line------------------------•-------------_- _ -' °.z - ---------------------- ---- ----- ----------------------------------------- Remodeling and/or repairing (describe): ------------------------------•---------•-----•-------------------------------------------------- �+ t t -- ( !' I ----------------------------------------•---•----------- --••--------------------------••---------------------------•---- -----------•----- I hereby certify that I have prepared'this applicafion and that the work will-be done in accordance�wifh San Joaquin County ordinances, State laws,:and rules and regulations of the San Joaquin Local Health District. A� ` Sc n I ( 'g ed) /s =.ZjZ------'' = r `.(Ow ner and/or Contractor) By:__-_----_---------------- ----------------------------------------------------- ---------------------------------------------(Title)-l------ --------------f ------ -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,':can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY"—- -_ - -------------------------------------- ---------------------- - DATE --- -- � - - - REVIEWED BY-----------_---------°---------------- - -- --------------- DATE-------�- .... 'BUILDING PERMIT ISSUED--'=---- ----•----------------- '4 • - DATE----- --- :-. •------ Alterations and/or recolnrnendations:------------------------------------------------- -----•--•--•------------------------------------- -------------- ------ -•---------------•-------- ----- --------- ---------• --------------------------------•-------- --------------• -------------•--- - - - ------- ----- -----------_----------- ------- - ---------------•- ,--. -- - -- - - --- - - FINAL INSPECTION BY:.4"------ ----- --------- - . - Date' ` s/--f----:- ------------------------ SAN - --------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street f 32 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-••-9--2M ; Revised W-2100 i