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APPLICATION FOR SANITATION PERMIT Permit No. 4--_ ___-_ :. ry [Complete in Duplicate] Date Issued __ f:�_._------- 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 O dinance No. 549. JOB ADDRESS AND LOCATION..___ - _.__ -Q___--_ - ------- - ----------- --------------------•--- ---------------------------------------------- Owner's Name ,... 7��jj _ q -- -------------------- ------ Ph'one.... 7-V------------ Address.. ;...... ----------------------------------------------------------------------------- Contractor's -------------------•---------------- Contractor's Name------ -�` Phone -4T 1 Installation will serve: Residence,K Apartment House ih Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:__- Number of bedrooms -�____ Number of baths ..�___- Lot size _______3_0_X-,�o _a, l - ------------------ ----------- Wafer Supply: Public system'❑ Community system ❑f Private ❑ Depth to Water Table !1_ ft. Character of soil to a depth of 3 feet:. Sand ❑ Gravel Illk Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes El No New ConstrMuction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'll' 01,Vaktianr: Distance from nearest well________________Distance from foundation________-_____.___- Material------ i. No. of compartments--------------------------Size-----------------------•--------Liquid depth_----------------- -----Capacity-----------------------�7 Disposal Field: Distance from nearest well__----___--------Distance from foundation--------------------Distance to nearest lot line_______-____._, Number of lines -----------------------Length of each line-----------------------------.Width of trench-- -------------------- _n --------- moi! Type of filter material------------------------Depth of filter material-__-_____- ---------._Total length----------------------_---------•---- -:-- . 1F See age Pit: Distance to nearest wet#_�Jm--------_--Distance from foudation_____'�'�______-Distance to nea - rest lot i;ne. ._a' Number of pits. ----�-----------Lining matlerial�l� r _ Size: Diameter---- 5- --`�.----.Depthe _ _0________________ Cesspool: Distance from nearest well-----.-----------Distance from foundation-----_--------------Lining material-------- ----- ❑ Size: Diameter - --------De`l`pth-------------------•------------------ ------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well__________________._I!------------------------..Distance from nearest building ❑ Distance to nearest lot line________________ Remodeling' and/or repairing (describe):-----dam" - a ,- ------------------------------------------- ------------------••------------------------ �� --------------- ------•----------------------------------------- -. ----------------------------------------------------------------------------•---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Signed ( ner and/or Contractor)( ( ------ ------- ---- -- - -- - ---- ----- - - 6J - ---A-- BY= -------I ----------- - (Title) l� -- --------------------- -- -- - - - ------------------------- (Plot plan, showing size of lot, location of Is fem in relations to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ) DATE 6 l-S ------------------ ------ REVIEWEDBY ----- --------CM------------------------------------------------ DATE-- -------- ± BUILDING PERMIT ISSUED-------------------------------------------------------�)--------------------- ------------ DATE Alterations and/or recommendations______________________ ------------------------------------------------------------------------ ------------------- ---------- ---------------------------------------------------•- -----------------------------------:GI-- -------------------------------------- •--------------------- - FINAL INSPECTION BY:.Y-.---_----- ----- - - ------• Date-------------��-- J_. 5,3 -- -- - -- - - - -------------------------------------- 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 10-52 Revised W2100 �