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APPLICATION FOR SANITATION PERMIT Permit No. ...._I/5—.`F.... (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. 1,49. JOBADDRESS AND LOCATION....CI-, -ez --- - -------- ----------- --------------------------------------------------------•--------------------------------- Owner's Name--- /1/1 `----- -----=----------------------------------------------------------------------------------------- Phone------------------------------------ Address---- l�4 Contractor's Name -" - .. r9L� -- -K��c-=�4'a------------------- ---- Phone------------------------- --------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑(Motel ❑ Other ❑ Number of living units: Number of bedrooms _ __ Number of baths __f__ Lot size ----------________________ i Water Supply: Public system R-1,community system ❑ Private ❑ Depth to Water Table 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No E��New Construction: Yes ❑ No Ej--r-IA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) S, Tank: . Distance from nearest well_________________Distance from foundation--------------------Materia4------------------------------------------------- No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-•--------------------- Dispos Field: Distance from nearest well_________________Distance from foundation_.-________________Distance to nearest lot line-____-___________ Number of lines-----------------------------------Length of each line------------------------------Width of trench-----------------_----------------- f4�,C1 Type of filter material--------------------------Depth of filter material-----------------_----Total length---------------.___-____________ -- or Seepage Pit: Distance to nearest well_V_ _�___'__'Distance,��,�ffprro foun anon__..f4f_____-_.Dist Distance to nearest I lin;_-_ ________ p Number of pits._:_,______ -___Lining materiall�l�_ CZSize: Diameter- s _____.____Depth____ t__ _________________ lV � t - �I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- ' El Size: Diameter--------------- ------------------Depth----------------------------------------------------Liquid Capacity- --------------------------gals. \, Privy: Distance from nearest well- ----------------------------___ _-_-. Distance from nearest building_______._--__________________•_____._. ❑ Distance to nearest lot P line---- ----------- � ---- ---------------------- lnandrepairi {clesr' ------- - Remod '� --—-------------------------------------------------- ----------------------------------------------------e ) -------------------------------- --------------•-•---------------------------------------------•----------------------------------------------------------------•------------•--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- - _ t -- --------------------•(Qw+tep-antll�ar Contractorl sy:. ------ - ----------- - ------------- ----------------------------- {Title)�f✓� �'�� (Plot plan, showing six lot, location of system in relation to wells, buildings, etc., can be placed on rever ide). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------- --------- ---------------------------------•-----•-•-•------•---------- DATE--------- ----------------------------------------- REVIEWEDBY------------------------------------------------- --------------------------------------------------------------------- DATE---- ---a BUILDING PERMIT ISSUED ----------------------------------------------- DATE Alterations and/or recommendations: -- ------- ------ t � ----- - ----- ------- ---------------------------------------•-----•-------------•----•--•-•------•-- —7----- ---- - ----------------- ----------------- ----------- Date_--- ----------------------------------•--- __1__ y FINAL INSPECTION BY______ __ ___ ___ _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1-57 F.P,CO.