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APPLICATION FOR SANITATION PERMIT Permit No=3 `S? (Complete in Duplicate) Date Issued af✓.'' ,Applica ' in 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 Ordinance No. S49. JOB ADDRESS AND L,OCA/,•ION > i ' Owner's Namfe 9-!--6 -- Pk�one. Address....yv-- •-----------•--------... -- ---------••------------- ---------- Contractor's Name - ------------------------- Phone Installation-will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑/M491 ❑ Other ❑ Number offunits: ___ __ Number of bedrooms __ Number of baths ___----- Lot size . 1 .___ -r- - _------------------- Water Supplil- Public system ❑ Community system ❑`Pr"ivate`❑""D�p�Fli to i/Va't 'r Tab"le__fir ft. Character of soil to a depth of 3 feet: Sand,E] Gravel E] Sandy Loam [j Clay Loam ElClay ❑dobe ®0 Hardpan ❑ Previous Application Made: Yes ❑ No E New Coistruction: Yes ®f No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-ifrp�ublic sewer is available within 200 feet.) ; Septic Tank: Distance from nearest well's �Distancj fro 1 foundatyon__ _ __________Ma}trial______-_____ _-__._____. ,________-______- ® No. of compartments-----_. -----____- ize-- --- _Liquid dep�t�h/��------- '-�--- -Capacity-/ �- `___ +� .Dispos Field: Distance from nearest we€-j 44 Distance from foundation -, ;istance to nearest lot I11P_ _______ I } Number of lin s___..__..- --s er.___ __-Alength of each line_____ _'_":Width of trefch-_______Z-"--`�___.._____ �,� T e of filter aterinn - t��l , De th of filter-ma'.ter+al_±-E:=_�,. '=_-___-Total len th__________ __ _ _ cSeepage Pit: Distance to nearest _______________ Distance from foundation-------------------.Distance to nearest lot line____----__--_____ ❑ Number of pits Lining material---------------------- Size: Diameter-------------------____.Depth------- ------------------------- / pp I Cesspool: Distance from nearest well---------------l_Distence from foundation--------------------Lining material___________-__--____________-__-______. ❑ Size: Diamete -----------------------------------!Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________________-_-----_---___Distance from nearest building- Privy: Distanceto nearest lot line---------------I---------------- ------------------------------------- ------------------------------------------------- ' _..._ t . . J � ----------------- �Remode' or repairing = : - ' h^ 1._... .--------' -------------------------------------------••--------------------------r-------- --`-----y--------------------- ----- I hereby certify that I have I pared this application-and-that-the•workLwili a dorre4n-accor,Aance- th San Joaquin County ordinances, Sta a laws, and rules Ind regulations of the San Joaquin Local Heal h Disfrict. {Signed} =-----------------------------------``-------- --- --------------------------{Owner and/or Contractor} - " A--------- ---_ " E Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY i I APPLICATION ACCEPTED BY`-- ---- ------------- ------------------------- -------------------------I------•__.. DATE.- REVIEWEDBY----------------------------- -- ------ ------------------------------------------- DATE � -.� BUILDING PERMIT ISSUED----------- ----------------------------------------•---------------•-------------I---------- DATE-•-----fir Alterationsand/or recommendatiAs:-------•------•------------------------------- -----=----•--------------- I------------------- -----•------------------------------------- ----------------- ---------------------------------------•---•-• ----------------------------------------------------------- --------------- --•------------------------------- ----------------------------------------------- _______________________________________________________________________________ _________ _______T_________________________________________________________________ __________________________________________________________ +{ I ---------------------------_---------------------------------------------.-------------__ _______.-______ f.. ------ -- __ _ __ ____.___________._______-___-__________ ____.__.z----------------------------- r0be ,�� ------------------- -------- ------------ ----- --------------- FINAL INSPECTION BY---------------------------1---------------- ------------ Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak S+reef 132 Sycamore Street 814 North "C" Street t Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Rovised W-2100