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APPLICATION FOR SANITATION PERMIT Permit No. ' (Complete in Duplicate) Date Issued A lice{ion is hereby i � � �- v PP y 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 AN LOCATION--------C�-- 3 r ---- r� Owners Name----- ----- ------ ----------- Phone-Ae --- Address 11 Z" - - ---- .�� t --------------- Contractor's Name----- LQc ,,:j........IC4 {2 `5� r = `'. ------ Phone Installation will serve: ;Residence ❑ Apartment HouseCommercial ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_ -i, Number of bedrooms -Z... Number of baths - - Lot size -------------------- - - - - O-Ca_ Water Supply: Public.'system ❑ „ Community system ❑ Private R Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [a--Hardpan ❑ Previous Application Made: Yes ❑ No ❑' New Construction: Yes [f'Klo ❑ 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---SD-_- Distance from foundation---_ __-..Mater �Fa]----- W _ No. of compartments-------- -----------_Size----3.k- k--7_Liquid depth--------- ------ Y ca__-CaP acit ---------- isp, offal Field: Distance from nearest well---,.�7---- -Distance from foundation-----tl ----.--Distance to nearest lot line---.._-- __-_ Number of lines------------ --�-- --- --Length of each line----- -----rr�------------Width of trench.---------Z�f yType of filter material-_ epth of filter material- ��------Total length--'---------- ---=Seepage Pit: Distance to nearest well-- -------Distance from foundation--------------------Distance to nearest lot line-_--_-_.-_--__..-X$ ❑ ` Number of pits----------------------Lining.material-----------------------Size: Diameter------------------- ---.Depth---------------------------------W Cesspool: Distance from nearest well-----------------Distance from ❑ foundation_._---.-.-__-__.-...Lining material----------- : -------------- ' _--'- ' -______5ize: Diameter - � -4 ----------------- --. pth----------------------------------------------------- quid a Capacity 9als.rn Privy: Distance from nearest well--'----------------------------------------------:Distance from nearest building ' ❑ ,.Distance to'nearest%t Dine:"" -------------------------- -----------=-- ----------------------------------- .- -------------------- Remodeling and/or repairing (describe)------------------------ -----------� - ------------••--------- -•------------------------------------• t -•----- ------•--------------------------------------- `--- - -----------------•-------------------------------- ' 3----------------,_-__--__-___----_-_---_________-____-.-.--_-_-..--____-----___--_.__--______.------_.___.___---___-_.-------____.----_-__-_._-__-.-____._.--__-_-- » --__--___--.---- _-.._---_---------_---.------..-__.- I hereby certify that-I have prepared this application and that the work will be done in accordance-with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 (Signe. {Owner and/or Contractor) ----------•------ By:------------------------------------------------------------------------------T T'fie ( t }-----------------------------------=---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on.reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- r" -- ------------------------------------------------------------------- DATE---------- - - - REVIEWED BY--------------------------------------------- - ------. DATE------ --- -�`_-- -- � l,F----- ----------- ------------- UILDING PERMIT ISSUED ------- ---------•-- •----- -------------------------------- - DATE.. ------------ Alterations and/or recommendations:.-__-- --------- --------------------------------------------- -------•---------••---------••-----------•------------------ -----=- ----------••---------•---•---s-- ------------- — s S i ---- FINAL INSPECTION BY:-- _-- -------------------------------------- Da, fe :.. 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 r ES-9-2M Revised W-2100