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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) �/n:_; 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 withCountyOrdinance No. 549. JOB ADDRESS AND LOCATION /u 9:�e-`C�e---y ----- `rr'�-------------- Owner's Name._ r_� ---- L�,� --- Phone qz� Address = .?% r%- -_----------- -------------------------------------------------------------- ---- ---- Contractor's Name --817 --------�-----�-------- • �------------------ Phon 7 � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M tel ❑ Other ❑ Number of living units: ____--- Number of bedrooms .-7,---Number of baths __I--- Lot size ___ Water Supply: Public systemmunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: 'Sand ❑ ravel E] Sandy Loam El Clay Loam ❑ Clay E] Ado be a0pan E]Previous Application Made: Yes [-]No New Construction: Yes ❑ No ❑ .- e TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tin Distance from nearest well A__: Distance from foundation------------------- Material ---__-----___.__--_-___-____----_---.--___-_--- o. of compartments -------------------------- Size --------- ------------,-----_-- Liquid depth -------------------------- .Ca aci -- -..is sal.Fi : ;stance from nearest-well..............:...Distance from foundation -------------------- Distance to nearest lot line _______.--_-_---- /] Number of lines-_---: ------:------------- Length of each line -------•----------------------Width of trench----------------------------------- Type ------_---_Type of filter material'__�,.-------_Depth of filter material____________________ Total length--k.________--_---.__----____-_,,_�,_- See a' e Pit: Distance to nearest wel __: _U__ ____Distant ou.dation-- __Q_.--_:-_-_. ist ce to nearest lot line -__d...____ Number, of pits---- --------=---- '"in ng material_?114_Size: [ ameter-- - tl---.De th__�„a�'0 Cesspool: Distance from nearest well -----__-_____-:Distance from fIr-dation--------------------Lining material _------------------ .-___----_---__-. ❑ Size: Diameter----------------- --------- ----------- Depth ----- 7------------------------------ --------------- Liquid Capacity ---------------- ---------gals. Privy:, Distance from nearest well---------------- ---- --------------- ------Distance from nearest building -_______-.--.--____---__-------------.._. ❑ Distance to nearest lot line----------------------------=-------------------------------~- ----- -•-----------------------•-------------------------------------------- Remodeling and/or repairing (describe}-------------------------------------•-----•-•-------------------•----...-•-----------•-------------------------------------•------------------------- - ,i - ----------------•-------------------- .-----------------•-----•----------------------------•------------y„ ------------------------,-------•----------------------------------- - -----------•---------------------------------------------------------------•----------•--------------•------------------------------------------•---•------- -•------------------------------------•-------------------- I her c fy that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance State I s; and pules and re ations of the Sa oaquin Local Helalth District. G• h (Signed) ----_..:S-.. ------ !_1--��. Contractors ---------------------- sY� - build in -5' --- � ---.._(Title �.J_Ii dla� (Plot plan, showing size of lot, location of system in relatio to wells, g c., can be placed on reverse side). .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ -DATE--�------•------------------------------------------- ----- -------------------------- -------------------------------------------- REVIEWEDBY---------- -•--------------- -- ------ --------------------------------------.------------------------------------------- DATE.----- :C -r BUILDING PERMIT ISSUED ------------------------------------------------------------------------------------------------------- DATE------- M 51 Alterations and/or recommendations: -------------------------------------- -•---•---_----- ----------- -------------•------------------------------------••-•-------------------------------•----•-------------------------------------•------------------ -•----------------------------------------- - -----------------------------------------------------------------------•--------------------------------------------------------------------------------------•------•-------------------------------- �0,7,��-foFINAL INSPECTION BY:Date-----/-T SAN JOAQUIN LOCAL HEALTH DISTRICT I 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California f ES -9-21A Revised W-2100