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APPLICATION FdR1 SANITATION"PERMIT Permit No. -P__.-___ (Complete in Duplicate) 1 Date Issued _ Application is her by 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, , JJ -----------------r ' JOS ADDRESS AND LOCATION_ t.r ------------- - -•------------------------- - --------------------------------- Owner s Name______________ ,/ I/ ------ --- -------------------------------------- Phone r , " Address----------------------•-••------------------ - -------------- Contractor's Name -------„-----------------=------------------------------------------ -------•- ---------------------- Phone----------------------------------- Installation will serve: Residence apartment House ❑ Commercial El Trailer Court ❑ Motel ❑ Other ❑ Number of living ung is ,{ Number of bedroom Number of baths Z..__ Lot size ____ ___�__ ,eJ_--__________-_ C Water Supply: Public system Community system ElPrivate"❑ Depth to Wafer] ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑'- Sandy Loam [E] Clay Loa, ❑ Clay 0 Adobe® Hardpan ❑ Previous Application Ma6:3,Yes ❑ No W New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Se tic Tank: Distance from nearest well '�,2�-_---Distls.arailable,within 200 feet.) ) (No septic tank or cesspool permitted if public-sewer p . . ante from found ion___.__ -,-4Acterial------0t-----y',0-4-E ------- �J No. of compartmen-Is------------------------Size:__f-.1r_-3-X---- ._.-Liquid depth_ Capacity--- Disposal apacity___ Number oz lines__________ 1.once from foundation-,eV _ Z---.--,--.Distance to.nearest lot Dis osal f=ield: Distance from nearest•well.,Y-0._ _---__Dist t p Length of each line g Type Depth of filter materia!____-�g__.______=Total length--C-___-,j; T e or filter material'____:; Q________-•_- Dist �± Seepage Pit: Distance to nearest well-_______- :- ante from #oundation____________________Distance to nearest lot line__-__-_____._-_ ❑ Number of pits----------------------Lningtmaterial--_--------------------Size: Diameter----•-------------------Depth------------------------_ Cesspool: Distance from nearest well------------------ foundation--------------------Lining material__-_______________________-___-______- Priv❑Y Sue: Diameter i De nth "'”' -" =Liquid. Capacity gals. Distance from nearest well-_--__________ _____________________:._.__Distance from nearest building___,_____--------------------_--____--.-. ❑ Distance fo nearest lot line----------------------- ---------------- ---------------I ----------' Remodelingand/or repairing (describe):----- ------------------ ------------------------------------••-------------------------------------------....._---------------•------------------• " I 4 ____________________________________________________________________________________________________ _ ___________________________________________________________________________________________ l I hereby certify that'l 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:,,.. 1 f -- (Signed)..---, a -- ---- --- ----- :-------------------------------------------------------•---------------(Owner and./or Contractor) Y Title i Ian, showing size of lot, Iota ton of s st�lotion }--- - ---- - -------- --- - --- --------( . )------------------------------- ----------------------------- (Plot - t p g y ;o wells, buildings, etc., can be placed on reverse side). FOR DEPS IST T USE ONLY r APPLICATION ACCEPTED BY--------------- ----- ,- -- - DATE--------- -/ --------------------------------------------- DATE------------------------ BUILDING PERMIT ISSUED..—... f_� l� �+ ---------- DATE :� --- ----- ---- Altera ions and or r comme a i s._ -- l / .� L ............. � I---------------------•----- -------------------------- -------__-__-------------------------------------------•-- ----------_-----------------_-------_----------------------------_------------------------------------_____--------____--------------------------------------------------------------------___________,_------------.______- 0?_______________________________________ _ FINAL INSPECTION BY:. ---------- --- --- Date ------ 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 io-52 Revised W-2100