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APPLICATION FOR SANITATION PERMIT Permit No. �?- � _--•- (Complete in Duplicate) Date Issued ---- Applica+ion 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. 549. ------------------------ JOB ADDRESS AND LOCATION � ------- `.-- a Owner's Name--..----- -- -- ------------------------------ Ph �'T-�l�,�'-�-�- ----- ---. -l�/�/__�7..-....----�---------------- one-- ..----�- -'t ----------- �lr� -1------------------------------•-•---------•-------------------•----•------- ' -------- Phone--�..12_ ---- - Contractor's Name------ ---0y_v'f ��' Installation will serve: Residence ❑ Apartment House F1 Commercial [_1 -Trailer Court [Motel ❑ Other ❑ Number of living units: _9---- Number of bedrooms ._f_ Number of baths -------- Lot size ------------------------ Water Supply: Public system Dommunity system El Private ❑ Depth to Water Table il"l9ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: !" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ank: Distance from nearest well-----------------Distance from foundation-------------------.Material---------.--.---__----_----------------------_. No. of compartments----- - ------.......Size--------------------------------Liquid depth--------- - -- ----------Capacity----------------------- Dis al Fiel 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 material----------------------Total length_---------_-_-_--------------__-_--___-- \ Seepage -it: Distance to nearest well--__ -_--Distance om oundation---/--Q-/ --�Distance to ne'arest.lot line.--l0_.---. Number of pits----- Lining material - ...__.Size: Diameter--��-//.-------Depfh..11j_s____1--------------- Cesspool: Distance from nearest well-----------------Distance from foundation-_-.-------------_ Lining material --.----.--_------------------------. ❑ Size: Diameter------ ----------------- ------------Depth--------- -----------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line - ----------- ------------ •--------------•------------•----------r------------------------------------------------ Remodeling and/or repairing (describe):--- -------------------- 7 ---------•--------------•----- -----------•------------•--------------•----------•----- ••------------- ! 4 -------------------•-•-------------------•-----------•__- ---------------------------------- I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-lawsr.and rules and regulations of the San Joaquin Local Health District. DAY&NIGHT (Signed) -Sep*,.TPPk SerYice- -- --- - --------- ------- ---- --- - ---- --------- (Ow r Contractor) 1206 So.Eldorado HO -7046 Title B -d-__----------------------------- y ------------------Stockton,-Ca g - (Plot plan, showing size of lot, location of system in relation tow s, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------•-- DATE------------------ ----- -------------------------- ------- -------- ---- ---------- 1W DATE- REVIEWEDBY-------------------------- -------------------------------------------- BUILDING PERMIT ISSUED------------------------------- - -- DATE. �-.... ----------- Alterations and/or recommendations-------------------------- -- ----------------------------------- --------------------------------------- - -- . - ----- ---------•----------•---------------------------------- --------------------------------- f- � ------------------•----------- ..---- ------------------------------------------ .------------ ----------- ------- FINAL INSPECTION BY:-----.- ---------- Date - � - Y � --,s<SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 A7WOOD 12-s4