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APPLICATION FOR SANITATION PERMIT Permit No.6__;�__©___-- __ (Complete in Duplicate) Date Issued 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION ----------- ---- - Owner's Name---- _� � ' ------- -------------- ------------ ------------------------------------ Phone------------------------------------ Address----- 11 ------ - � "� ---------------------------------------------------------------------------------------------------------------- --- ---- ------ - I Contractor's Name--------------------- Phone---------------------------------- Installation will serve: Residence Da Apartment House ❑`` Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms 1.-- Number of baths J____ Lot size ---- __ °"°!-_ _--,---- -- -------------- Water Supply: Public system ❑ Community.system '❑ Private ® ,Depth to Water Table 4"Q- ft. �- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Qf Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No X New Construction: Yes V No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic Tank: Distance from nearesf we€I____ __' _Distance from=foundation='0_ ___`Material- a°' — f No. of compartments-------. ------Size--------- -- ----------Liquid depth---------------- Capacity - !__-- Disposal Field: Distance from-,nearest well40--------Distance from foundation_________4--- __Distbnce to nearest lot line_____S I Number of lines_________i-----------------------Length of each line---- 0-_______________.Width of french__-•_`�____ Type of filter mate Depth of filter material'______-i_�jl.r_-----Total length------- Ga--------------- r 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------------------________-_________ _-___' __Li Liquid Capacity P _ _ q ------------------------ -------- --� _ _��_.�_. _ .�,��___ �-,..�—:,-„�.' Dis+an from nearest building _.._ _ _ Privy: Distance from nearest well__ __ _ _ ________ ____ ___- _ ce eare b 'Id'n __________.______ _.----------------- 1771 ___________ __❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing ('describe):----- -. -- ----------- `, c.., -- -J----=------------------------------------------------------------ ---------- zfat�2 c�...kn �- --G -- -- ---- - - ------------------------ ------r------------- I hereby certify I ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,,and ru s and regulations of the San Joaquin Local Health District. /VV -----------------------' _-'_------- ----------------------- (Signed) [Owner and/or Contractor) -- ---------------- ----------------- BY= ------------- `------------------------------ -------------------------------------------------------- Title)------------------------------------------------- ,;— ------------=------------- --------_--- ,;—='Plot plan;showing size of-lot,•location of sys+em'in-relation-to wells, kiuildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- DATE �� ` ' REVIEWEDBY------------------------- J ---- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----------------------------•----------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:------------------------------------------ -----------------------------------------------------------•----------------------------------------------------------- ----------------------- --- ------- --------------- - �-z7/) -------- ------------------------------------------ -------------------- ---------------------------- --------- - -- ------------------------------------ - ----- -----------------------/------------------------------ ----- - --- ----------------- -------------- ---------« -------------------------------------------- ------------------ - =--------- ---------------- -------- -•---------------------------------- --------------------/----..----------------------------'-r-------------------_- 2, FINAL INSPECTION Y— ----- ----- - --------------------------------------- Date-------------------- ,� SAN JOAQUIN LOCAL HEALTH DISTRICT z 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 8-51 Revised W-2100 w