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APPLICATION FOR SANITATION PERMIT Permit No.�ZsA_o---]I_-__.-- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health Di rict for a permit to construct and install the work herein described. This application is made in compliance w h Cfunty OrdinaYK// o. 549. JOB ADDRESS AND LOCATION-- - -0/ -------- ---------------------- ---------------------------------------------------- ------ Owner's Name---------------------------------------•--------- ©2------ Phone ---2-�9 ' Address---------------------------------------------- ___---- - ---�=------ ----------- ----------- --------- � ��'-------------------------------------------------- Contractor s Name Phone--- = Installation will serve: Resid ce Apartment House ❑n Commercial ❑ Trailer Court ❑ ,� ---Motel El Other El Number of living units: _-;� Number of bedrooms 4"'Number of baths __, __ Lot size ___4 --- 'r �J Water Supply: Public system [2f, Community system ❑ Private ❑ Depth to Water Tablep;14S ft. /��.....,..j Character of soil to a depth of 3 feet: Sand E❑ Gravel ❑ Sandy Loam E❑ • Clay Loam ❑ Clay ❑ Adobe [K Hardpan E❑ Previous Application Made: Yes 0 No ❑ New Construction: Yes ❑ No ❑��yp ,� J I TYPE OF INSTALLATION AND SPECIFICATIONS: 'f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank: Distance from nearest well-________________Distance from foundation-------------------Material----_-_____----____-_ .No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity---•-- ------ D' sal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----_---._-----_- , - Number of lines-----------------------------------Length of each line------------------------------Width of trench.------•--------- Type of filter material-------------------- Depth of filter mate6al-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well-So istant f fo ndation-_ f £� - , y L_s�"...-..Distance to nearest lot line___..-_�--_ � Number of pits-----J_.__--------Lining _material��-__Size: Cesspool: Distance from nearest well-----------------Distance from foundation_-------------------Lining material_______---__--________-_____ ❑ _ Size: Diameter-------------------------------------De Dept ------------------------------------------------Li Liquid Capacity -----------gals. p 9 p tY---------------- Privy: Distance from nearsst well_-°' '"_-:-: ____V_______ ________�_ -_.Distance from.nearest building-----_-_-_____-__-_- _. ea ------------- -•----. ❑ Distance to nearest lot line__ Y"- -.- ,- Remodeling and/or repairing (describe):_-__ ._ ____________ ________ - -- --------------------- ------------------------•-----------•--------------------------------- --- ------ --`r-----yam...... = -------------- ------------------------------- -----------------•--•------------------------------- 1 ------•--------------------------------------=--- ---------------------------------- ------------------•------- I hereby certify that I a e prepared this ication a that the work will be done in accordance with San Joaquin County ordinances, St a laws, a r les and regulafi of the Sa Joaquin Local Health District. (Signed)------- n'<'----- ----` -- Q ------- �r ontractor) By: ---------------------------------------------------------- ------------------------------------- ----(Title)---- ---�-�/ e- -- -------------------- (Plot pl 'size of lot, location of s m in relation to wells, buildings, etc., can be pl ted on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-_ ---.-_ ----------------- DATE -------------------------------------------------- REVIEWED BY - DATE ---------------------- �P BUILDING PERMIT ISSUED- ------------------------------------------------•---------------------------- ------ DATE-------------- - ---�--------- -------------- A terations and/or recommendations------------------------ - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- ----------------------------------------------------------------- --------------------- --------------------------------------------•----------- -------------•------------------------------------ __ " FINAL INSPECTION BY:---------- �__ _ q7/_s__(—------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S}reef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 6-51 Revised W-2100