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APPLICATION FOR SANITATION PERMIT Permit No. ...2.7-- "-'- (Complete in Duplicate) pate Issued ----7_ 2--7 -2-�' Application 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 ounty Ord' ce No. 544 JOB ADDRESS AND LOCATION ` ��fl� _ Owner`s Names� 2i`�-- ✓ Phone- - ...... ' - ------------------ ----------------f-�-------a--------.-- ------ . -..Address 8 - 7 Contractor's Name------------------ -------j Phone Commercial ❑ Trailer Court ❑ Motel ❑ Other El, Installation will serve: ResidenceApartment House ❑ Number of living units: _1--- Number of bedrooms f Number of baths .-j--__ Lot size - --- ----- - j_4!--------------•-------------- Water Supply: Public system K] Community system ❑ Private ❑ Depth-to Water Table,- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ 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.) F tic,wT nk: Distance from nearest well-----------------Distance from foundation___----------------Material--------___----------------_-------------_-----. I- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- �spos I ,Field: Distance from nearest weh-----------------Distance from foundation__--_---_____-__-__Distance to nearest lot line__-----_-_-_-_--- • �l Number of lines-----------------------------------Length.of each line------------------------------Width of french------------------------------------ Type of filter material-_ _ Depth of filter material-- ----------------- Tota! length----__---__----- -_---------_____---�_.- q�iyl�n�o 1'IE'� i ` See age Pit: Distance to nearest well ___Qisfiance fr m ounclatiorils-___---_.Dist Distance to nearest lot j�e-l._�______-_ Number of pits-----�--------------Lining material-----:----�-------Size: Diameter---��------_----.Depth_�-+�---------------------- Cesspool: Distance from nearest well----------------Distance from foundation--------------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth--------------------------------------------- ------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot lino -------- --------------------------------------------------------------------------- Remodelingand/or repairing (describe):-------------------------------- ------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (� w Contractor `"'_ -- ---------------- ------------------------------------------------------(Title) -1 n Z (P Q [Flot plan, s ow' ize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- - - PATE----_ _ ___ ----------- ----------------BY-------------------------------------- - - ------------------------- ------ -------------------------------------- --- BUILDINGPERMIT ISSUED-------------------------------------:---------------------------------------------------------------- DATE----------------------`/-------------------------------- Alterations and/or recommendations=-----------------------I----------- -------------------------------------------------------------------------------------------------------------- -•-------- -------- t------------------- -- --------------- ----------- ------ ------------•------------------ -------------------------------- FINAL INSPECTION BY.--------- ` - `- ------ ---T------------- Date---- ZZ- 1� 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 I ES-9--2M 8-51 Revised W-2100