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�1 y Permit No APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued - / -5-- � 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. JOB ADDRESS AND LOCATION--------I-Ygj(�-------------/�1'A' 1-'--1_7 ------S--------------- ' --------------------------- Owner's Name-----------%)--o ll ------- Et'`s `-N--------------------------------------- Phone-- -'-6_ a.- ------- Address-------------------f-_- 'C---------6F= =-s-o rf a......5-?= ' Contractor's Name----- c t��- 11 t - ?-I '.- H------ -------------------------------------•-- ----------------- Phone.,S--37r 0-7----------•- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --I--_ Number of bedrooms Number of baths .--/-. Lot size __- -`----------------__.-- Water Supply: Public system [A Community system ❑ Private ❑ Depth to Water Table -yQ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ® Hardpan ❑ Previous Application Made: Yes [❑ No [;F New Construction: Yes ff] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: , Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- El No. of compartments------------- ------------Size--------------------------------Liquid depth---------- ------ --------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line----------------- F1 Number of lines-----------------------------------Length of each line-----------------I-----------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length-------.-__---.-.------------------------- Seepage Pit: Distance to nearest well_Wl_&. ----Distance from foundation------�0-f----.Distance to nearest lot line---4(-42 ® Number of pits-_.--.1------------Lining material-Z_C--/_hZZ eSize: Diameter--------3_,3--- ----Depth-.-.--- Cesspool: Distance from nearest well-----------------Distance from foundation-----_------------.Lining material-------------------------------------- F-1 Size: Oizrmeter--------------------------------------Depth--------------------------------- -----------------Liquid Capacity----------------------------gals, . Privy: Distance from nearest well---------------------------------- ----------Distance from nearest building---.------._-----------.-----------------. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------- ------------------------------------------------------------------------------------- ---------------•-------------••-------------------•---- ----------------------------------•--------------------•----------------------------------•--------------------------•-•----------------- ----------------------------------------------------------------------------- -----------------------------------------------------------------------------•------------------------•-------------------------------------.-------------------------------------------------------------------------------- I hereby certify that I have prepared +his application and that the work will'be done in accordance with San Joaquin Coun+y ordinances, State I s, and rules andre ulations of the San Joaquin local Health District. a (Signed)........ ``'�`e'L- v '------------- -----(Owner and/or Contractor By: '= I�' ------------ ---{Title} �® "�{-! - ---------------- (Plot plan, showing size of lot, location of system in relation to wefts, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- i - ' DATE_ -------------------------------------------------- ., , REVIEWEDBY------------------ ----------- -- - --- ------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------- DATE------f Alterationsand/or recommendations:_-------------- ------------ -------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ------------------------------------ -------- ------------------------•-------•--------------------------------.------------_---------------------.--------------------------------------------------•-- ----------------... FfNAL INSPECTION BY:.,'-4 - --------'�`4' -' �. ------...- Date--- ----------- ----- -- ------- --------- ------------------ -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Stree+ Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 30-52 Revised W-2100