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- -j-e2_ +` APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Appliceion 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 Ordinan e No. 549. JOB ADDRESS AND LOC IONf/G_ -: r_ �"' J-------------- ------ --------- --- f.T1 l.`-------------- .. Phone ----------- Owner Q---' ` Owner's Name.-------------------- •- • - -----�--- - -�--�-�---------- --- -------------�----�Address------------ ------ i --------- - ��.- Contractor's Name �1'/�!_S`f �7 ------------------------------------- eI� O Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ II Number of living units: __!__-- Number of bedrooms ---/_ Number of baths ___/_ Lot size _____. ._�V__ _ . -_ ..__F-4------------------ le Water Supply: Public system Community system E] Private E] Depth to Water Table ft.'7f' Character of soil to a depth of sett: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay oam ❑ Clay ❑ Adobe Hardpan ❑ 7� RPrevious Application Made: Yes ®' NoNew Construction: Yes ❑ No ❑ _!YTINSTALLATION AND SPECIFICATIONS: f No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Tank: Distance from nearest well_________________Distance from foundation-------------------.Material ________-__---.__--_______._._3---------------- No. of compartments------ -------------------Size-------------------------------•Liquid clepth ------=- ------Capacity----- -----•----------- � Disposal Field: Distance from nearjst well jLl.rDistance from foundation__/1�__--_____-Distance to nearest lot line___- -_______._ 1 Number of lines____!-__________________ __ _ Length of each line___�_.� ------.Width of trench___ __ ___�'' Qn,1 n Type of filter material-__ �k15�__Depth of filter material----�g��___-:_Total length- -- ___________.__---____- v � J —"6 �Distance to nearest lot line____ ro�0�1: Distance to nearest well_____--Distance from foundation... .............. --- Number of pits._-----------Lining material�F------------Size: Diameter--�.3-�'1-------Depth_.., __-- i Distance from nearest well_________________Distance from foundation-__.__-__--_._.._--Lining material____----_--__.._--____________Size: Diameter_____________________------ -------- Depths`:--=---- -----------------------------------------Liquid Capacity---- gals. , yDistance from nearest well____________________________.___.------------..-Distance from nearest building____.__----_____________-.__.____w---.-. ❑ Distance to nearest lot line------------•---- --------------- -----------------------------------------------------------------•----------------------------------------- Remodel' g and/or repairing (describe):____ -- - ��'`�` "x"z` f ----- ,--- ---- - --------- - - - -------- �`----- ----------------------------------------------------------------- ----------------- -- - - - ------- I hereb cert y that I have -1re�sred this application and that the work will be done in accordance with San Joaquin County ordinances, ate ws, and ru es and egulatio s oft San Joaquin Local Health District. (Signed) Contractor) -- ----------------- By:-_------------------------------------------------------ ------ (Title)-- �� Q-r----------------------- (Plot plof lot, location of system in rel tion to wells, buildi s, etc., can be placed on reverse side). FOR EPARTMENT USE 6NLY, APPLICATION ACCEPTED BY --------------- ----------------------- DATE ---- ' REVIEWEDBY---------------------------------- ----------------------------------------- -------------------------------------- DATE--------..---- ._-.._..-- BUILDING PERMIT ISSUED------------------------------------------------------------------------ ----------------------------- DATE--------------- Alterations and/or recommendations------------------------------------------------------------------------------------------------ ---•--•--•---------•------••----•-------------------•---------- ------------------------------- ---------------------.-----------------------------------------------------------------•------------------- -------- -- ----- FINAL INSPECTION BY---------- - -- � - ---------�i------- 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 { E5-9-2M Revised W-2100 + `