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_y APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued Applica-�ion is hereby ma a 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 Or 'nance No. 549. JOB ADDRESS AND yLOCATION...... � -------.--t--c---P-�-- cI -------------------- Owner's Phone - •� � Address--- �---- • ` --------------- ��//-__--/------- --------------- Contractor's Name L �' Phone.-' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/-- Number of bedrooms ..3_ Number of baths _Z-- Lot size _47. 0 ----------------------- Water Supply: Public system ❑ Community system g Private ❑ Depth to Water Table Za_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Or Hardpan ❑ Previous Application Made: Yes ❑ No 1WNew Construction: Yes +' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _Distance from foundation--��..........Mategiai-_---<f.... Hr- No. of compartments------C:P,-:------- ---- Size--:� �.j-� -- __--------Liquid depth--- - -.____-_.-Capacity-•- __4!1__ ----- Disposal Field: Distance from nearest well__!--''}}. Distance from foundation•-�_*---_-Distance to nearest lot lire----------------- Number of lines-------- -- Length of each line�la_'6 �_.6�--------Width of trench----- -y-------------------- Total -- - ------------- Type of filter material._s��-_____._._Depth of filter material_--.-/,9-f/------ length...... Ll------------------------ 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 herebtle tify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, laws, and rIA and regulations of the n Joaquin Local Health District. (Signed)--•---- -----�`� ------ -- - n -------(Owner and/or Contractor) - By----------------------- ��-•' *- - ----------- •-------------------------------------(Title)--- � f ------------------------ (Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- ----------------------••--------------------- DATE REVIEWEDBY--------------------------------------------- ------------------ --- ---------------------------------------------------- DATE - - - BUILDING PERMIT ISSUED--------------_--- ----- ------------------------------------------- DATE.--------- ---------- Alterations and/or recommendations---------___-------------- - ----------- -----------------------------------------------•----------------------- -----------------------••-------------•--------------..-..-------------••- --------------------------------------------I-------------------------•-------------------•-----------------------------------•--------------• --•--- ----------------------------------------------------------------- ------------------ c FINAL INSPECTION BY:------- ---------------------------------- Date--------?--- - - ----� ----------------- ---- 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,•Celifornia ES-9-2M ; Revised W2i00