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APPLICATION FOR' SANITATION PERMIT Permit No. ~� 9 7 (Complete in Duplicate) z ' Date IssuedSl/�/S Application is her made to the San Joaquin Local Health District fora permit a This application is made in compliance with County Ordinance No. 549, ry -��- ]e p to construct and install the work herein described. ZAA101 * � y JOB ADDRESS OCATION_._ 00. �.. Owner's N , ame . �, V f�� -.,--_-------------=-------------- Address + Phone- = - : ------------------•---------------- ----- ontrector`s Name ---------------- t Installation will serve: Residence Phone---------- ,.�a+ ❑ Apartment House ❑ Commercial ' « ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: __7.-__--_ Number of bedrooms _- ---- Number of baths __.----- Lot size ------------------ Wafer Supply: ,Public{ 3 - ------ ----------•------- system ❑.' Communify system ❑ Private ElDepth to Wafer Table----------ft. Character of soil fo'a'depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y Loam Clay Previous Application Made: Yes ❑ Clay El Adobe❑ No ❑ New Construction: Yes ❑ No El Hardpan ❑ TYPE OF INSTALLATION AND SPEC IFICATIONSc � ❑ (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic_ Tank: Distance from nearest well__p-- --__-_ -Distance from foundation-------------------Material_-____________ ❑ Noe of compartments-._-___--__- _ Size-------------------------------Liquid depth-------- Capacity. ----- --•-----------'- Disposal Field: Distance from nearest well---------- Capacity___--_.--_-- Distance from foundation--------------------Disfance'to nearest lot line-_.--_--..--_- ❑ - Number of...lines-------'------------ ----'Length-of'each line------------- Type of filter material- r Widthf of french-.----- ' -----.--Depth of filter material---_-_-.-_.-_---_----Total length__!_--_-.-___- Seepage Pit: I isfance.to nearest will _:'"`�"" ----------- _----Distance from foundation_- `_'`:___, ❑ Number of pits-------r r = Lmrng material-------------- Distance-fo nearest lot line------s-__---_-- m Size: Diamete'r------------- ----------Depth------------------------ Cesspool: Distance fi•om,nearest well_--_--_-_-__- k , � __--_-- --.:D i Depth -- from foundation--------------- Lining material----------- --------------------------------------- Distance❑ Size: Diameter------------- ------- -- p ------ ----------------------------------Liquid Capacity ------- Distance ------ -gals. l�- PrivY: Distance from nearest well----------- ------- ---- - - ' Distance from nearest building---Di tance'to nearest lot line = ='-Y--------------"---- = = Re del and/ory.rd_airi (describe}:_ t ` --------------- ��"' --- - _.-- -t , -- - .- : '_ l hereby certify that I have prepared this app licatioin accordance with San Joaquin County ordinances, State laws;'and rules and regulations of thn and that the work will be donee 'San Joaquin Local Health District. r (Sign e d)- 4 , --------------------------------------------------- --------•---------------{Owner and/or Contractor) 4 ( P By:------- t - _ --------------------------- -- - S Plot lan showing size of lot, locafion of system in relation to wells, buildings, etc., can(be I placed on reverse__ _side). ` ._: FOR DEPARTMENT U5E ONLY APPLICATION ACCEPTED BY- REVIEWED BY I i IN- ----- ---------------------------------------------------------- ------------ DAT --------------BUILDING PERMIT ISSUED--------•------- -------= ------ DATE---�--- Alterations and/or recommendations:----------•------_---- - DATE-------•--a. - ---- --=-------------•-----•-------- ----- - ------- ------------------ •-- -------------- ------------------------- ---- ---------------- FINAL INSPECTION' BY::-_ r----:--- - _ = 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 ; L Revised W-2100