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APPLICATION FOR SANITATION PERMIT Permit No.3--7- --- __-_.•• (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 complian e-wit County Or 'nance No. 549. �yL ' JOB ADDRESS D L CATI _ _______________ _____________ ✓Ii------ 7>� .� ------- ----- •----- ----- �7 / Owner's Name-- ¢' �� -------------------------------- ------ -------------_;-------- ------ Phone--(f o {� Address-----J-3.�-.Q-. :. --•---------------- -------------------•------------•----------------------------••------------- ---------------------------------------- Contractor's Name--- „ Phone -----------------•---------------- ----------------------------•------ Installation will serve: Residence tQJApartmentl?House ❑ Commercial Trailer Court II ❑ ❑ Mofei ❑ Other ❑ Number of living units: _lumber of bedrooms -Z_ Number of baths J--- Lot size Water Supply: Public system Communifiy syGstem E] ---------------—--------- Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand.11 I] Gravel E] Sandy Loam • Clay Loam [-] Clay E] Adobe 2---Hardpan 01 I Previous Application Made: Yes ❑ No LK NIL Construction: Yes [vNo ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i�pulblic sewer is available within 200 feet.) h ��5e tic nk: Distance from nearest well_-_--iY--_-------Distae fro foun tion__----------------.Material -j_____.__ .__ __-.-.-__-- p ems! - No. of cor partmenfs--------�. --------- iz ..----x- Liquid depth.- ----- - `T -----Ca pacify�_�� -- - -- p Y DispoosjVField: Distance from nearest well s__-----_._. istance from foundation__(/-�----- -14ance to nearest to lin ------------- l�f Number of lines---•------ �p ,q J/ --- --- - ------ -Length of each line__--:----_- -- Width of trench.-- Type of filter materi�� 1 r------------- --- epth of filter material------l-- .-------Total length--------�_ /_ -------- u Seepage Pit: Distance to nearest well,--_-_--_^.----------Distance from foundation-------------------.Distance to nearest lot line._-----_---_-.-.. ❑ Number of pits----------------------LimIing material---------------------- Size: Diameter--------- ------------ Depth------ -------------------------- Cesspool: Distance from nearest well-_---1�----------Distance-•from foundation--------------------Lining material- - ----------------------------------- ❑ Size: Diameter ��---------Depth------------ -------------- -- qq - - ----------- --Liquid CapacitY---------- ----------- - --gals. 't Privy: Disfance from nearest well__-0-----------------------------------------Distance from nearest building ❑ Distance to nearest lot line—Al - ---------------------------------------------------------- Remodeling and/or repairing fdescribe------------------- ----------------- ---------•-------------------•------------------------------------ ---------------•- -------------------------------------------- ---------------------------------- ------------- a i _ ------------------------------------------------------------------------------------ ll I hereby certify t t I have pre red . is application and that the work will be done in accordance with San Joaquin County ordinances, S la , A-ncl s re I tions of the San Joaquin Local Health District. (Signed)..- ----- --- -------- ----.----(Owner and/or Contractor By:------------------------------------------------- - --- �Iu Title ----------- ----------------- (Plot plan, showing size of lot, location of system i. relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ________--------------Ih ---------------------------------------------------- -- DATE"' REVIEWED BY---------------------------- - �b --------------------------------- ------------------------------ --- --- DATE--`�------------------- BUILDING PERMIT ISSUED.--------•----•-------'--------------- --- .----------- DATE..------ Alterations and/or recommendations:--._.-.-_--_.--.._-_-0-_-_____-_ -------------------1-1------------------------------------- --------------------------=- ---------------------------------------------------------- IIN ----------------------------------- - ------------- -- ----------------------------------------------- FINAL INSPECTION BY:--------- - -- - - Date—4- ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street111 300 West Oak;':S}rest 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100 1�