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� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) /p O Date Issued __. __�--- /b, Application is here mads to the San Joaquin Local Health District for a permit to construct and install the work herein desc . This application is made in compliance with County O inarnc o. 549. JOB ADDRESS AND LOCATION '�----------------------- --------------------------------y-------------------------- / ' Owner's Name l" "� •�.E--!-5.. -- -------- ---------------------- ---------------------- Phone--------�—6-6-1--------- Address - = - --------------------------------------------------------------------------------------------------------------- Contractor's Name ..---------------------------------------------- Phone., i__ `l Installation will serve: Residence A_ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I--- Number of bedrooms 7�"Number of baths -/---- Lot size ----7J""- j--6--0--r--------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ (-;la ❑ Clay ❑ Adobe - Hardpa ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE TALLATION AND SPECIFICATIONS: G' No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well----.------------Distance from foundation-------------------Material_.-___--___.-...-_._.-.------_----_.-_---.-__-. No. of compartments------ Size--------------------------------Liquid epfh--------------------------Capacity----------------------- osa Distance from neare t well fit-_Distance from foundation__ ----------Distance to nearest lot 1i e______ Number of lines----------_ Length of each line--- *, _P_.. Width of trent _._oL�` ______________ W Type or fili•er material_�__`�-_--._��•_--_Depth of filter mater�a!___.._._��_.__-_Total length_-. .__7-�__ __________1...4 Seepage Pit: Distance to nearest well------------------.---Distance from foundation------------------- Distance to nearest lot line--.--.-_--._--___ ❑ Number of pits----------------------Lining material---------------------- Size: Diameter-----------------------Depth-----.-.---------.--------------- "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- -------------------------- -------------- - -•-------------------------- --------------------------------- Remodeling and/or repairing (describe)---------- -----------------------------------------------------------------------------------------•---------------------------------•----------------- --------------------------------------- ----- ---- -------- -----•------------ --------- -------------------------------------------------------- --------------------•------------------------------------------- I here that hav this appli tion an that the wo k will be done ' accordance with San Joaquin County ordinance State la 'rule- re ulations the San aqu n_Loc ealfh D' 1ct. (Signed) ----- Contractor By-------------------------------------------------- ----------- ---- - ---------- -.------------- ----------(Title ----- - - -- ---------------------- (Plot plan, showing size of lot, location o system in relat' q we Is,-build' , etc., can—t aced o everse side). r FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY--------------------- -- ---- DATE------rQ/-7�tQ�'-r ---------------- REVIEWEDBY - ------------------------------ ---------- -1----------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------•-------------------------------------- DATE--------------------------------------- -------------------- Alterations and/or recommendations:------------------------------------------- -------•--- ---- ----------- ,� n �. --- --- - --- - ------- - ------------------------------ - - x'� ---------=- -------- - FINAL INSPECTION BY: �l -------------------------------------------- Date.-------------------- --------f--------------------------------- - - --- --------------------- 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 ES=-•9--2M to-52 Revised W-2100