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t APPLICATION FOR SANITATION PERMIT P '_ laA ermit No, �e�..�'iGv (Complete in Duplicate) �Date Issued . Yo ",�-- Applicafion is hereby made to the San J oaquin 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. __ " . . - Owner's Name ----------------•------------ -�� _ ' ,----- -- ---------- --------- ------------------------------- Phone----&":_ . Address-------- ,r�_ � ______________________________________________________________________________________________ _____ ___-___._.___-_____- Contractor's Name_.."___.____-__""__"_, •--�^ _• ^ ------f ------ Phone-- 9- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court I E3 Motel [:j . Other ❑ Number of living units: __r__ Number of bedrooms __Y Number of baths _-J-_- Lot size ----.,;Z_"" _/ S•""""-" Water Supply; Publics stem "___--___.. PPY� y ❑ Community system ❑ Private Depth to Water Tal�le.�Q. ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No44 New Construction. YesX 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 w 111_6A -----Distance r from foundafion-- f4",Material____ -� No. of compartments_ Ri Siz P e' a� rr e+ '� H Liquid depth)` ��- - Ca acit h v 5' O Disposal Field: Distance from nearest well.. Q ' Distance3rom�f�oundafiop__�,�" __.._.Distance to nearest lot line__"" 0f" Number of lines___.___. _ Length of each line8-- --_" �.3 Type of filter material_ r �� Width of trench.._a _ "------------""-" 1 Depth of filter material"��- -� Total length___c* _Q------------------------ Seepage Pit: Disfance fo nearest well---l-QO_'---__-Distance fro foundation_______- Q p' tante to nearest lot line-_. Number of pits-------- ._ "______Lining material y. ---Size. Diameter__.- --------..Deptn�------�fl 1 Cesspool: Distance from nearest well________________ Distance from foundation_-.__-_-__-_____-_.Lining material-._-__-_--____------------------------ Privy. ____.." ' ❑ Size: Diameter---- --------------------------- ------------- Distance from nearest building gals. - - - - ---=-- -- --- Liquid Capacity------------ �-----•------------------- Privy: it+stance from nearest well Distance to nearest lot line--- _ ---------------------- -----------------------------------------------------------rRemodeling and/or repairing (describe):__.___---------- ^--u t ----------------- -Z ------------- - --------------------------7""' 1L`7- ------------------------------------------------------------------------------ ------------------------------- 1 hereby cePis, f I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, Statnd rules and reg lations of the San Joaquin Local Health Disfricf. (Signed) ------------------ --- -- --------- - ----- --- --------------------------------------- 8Y� � Title)-- ontract or] (Plot plan, showing size of lot, location of system in r ation fo wells, buildin etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY________ I DATE-----------BY - U -- e f F - BUILDING PERMIT ISSUED. - ------- --------'•---""""-- "-- --------- DATE-------------------------------------- ---------------- DATE cera#ions and/or recommendations: " --•--- -- ------�- --------------------------------------------------------------------------------------------- FINAL -------------------- -- FINAL INSPECTION BY__________ __ _ - Date----- -- ---- "----. ---- - �-- - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 360 West Oak Street 132 Sycamore Street E14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100