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' APPLICATIONyy q p FOR SANITATION PERMIT Permit No. ----------------------- (Complete C---[, _-- __(Complete in Duplicate) el Date Issued --/ Nplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance with gounty Ordinance No. 549. JOB ADDRESS AND LOCATION.____ x , ------ -�-----� -----;�------------------------ Owner's Namef ` + Phone -- 3----- ------ ---- Contractor's ---------Name __•_ ; - ----------------------••-- ---��-------- ------------.- ------- -:---------. Installation will serve: Residence E] Apartment House E] Commercial ❑ Trailer Court ❑ 'Motel 0 Other J�,d,� Number of living units: __Number of bedrooms _� ._- Number of baths _ /Cot size _____ '� ---6_6------A----- ?—�p- - ---- ------ Water Supply: Public systemA Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of,3,feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam El Clay ❑ P,do eJ ,Hardpan Previous Application' Made: Yes 0 No� New Construction: Yes ❑ No �/�, � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 t r� Distance from nearest well-----------------Distance from foundation__.----------- No. of compartments S ------Material----_- _ =,--_ -------- ------•-------------------------Liquiddepth---------------- �) ------ Capacity Disposal Field: Distance from .neares well.l �---Distance from foundation_f9.�--___---Distance to nearest lot line__ J---- Number.ov lines'__ -------�_.7!F�____ -_Depth of filter material_______-A y r - ^��h:C.c___Distanc�roundatidr-jOW!�7[Di_ Totalnle length /�/ + Seepage Pit: Distance to nearest w"ells _ n lot line_'Number.-of pits_____ f. Lining materia `- Size Diameter_- ---f q ` " e Cesspool: P lstanc )from nearest'-well---___- F Depfin- C 0>7 - D. , Distance from foundation_-_._ -°- t ia" -Y ---------Lining material'.---- ------ ❑ iI e: Diamet@r sI i�"--------------------- De�nth LigUd Capacity-' l f 1`l gals. Privy: Distance o nearest lot-t ell----`---=------------------------- _ -_ _ Distance fror�n neares( buildin g Y= Distance��r��n�ear wne -....... - - --- --�_ f ) Remodeling and/or repai?ing (describe):-'_____r - _ -- --��__�:.:.Y: i ----------•----------------------------- -------------------------------- - -- -..-�-_ �. --------------------------- ----------------------------------- --------•---------------------- ---- - - - ----- I hereby cerci at a- prepared this app!' tion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and mile and re .ulaN ns a San Joaquin Local Health District. (Signed)---- ------ - --- - ............................ --- ---------- --------- ----- -------------------- By: Contractor) - ------- - --------------------- ----------•--------- By:. ----•------------------•-----•------•- --- ---- (Title)-- (Plot plan, showing size of lot, location of system in relation wells, buildin ti , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATfON ACCEPTED BY--- '7'- - _ ,",' - - ----------------r------5---A-- DATE L./- 7IEWED . --------- 5-; 6Y -------- DATE. DING PERMIT 15SUED-------------------- --------------- --------•------- ------------------------------------------------------ ------ DATE------ ------------------- - - - Ato ations and/or recommendations:---------------------- -----------------------------------------------------------------------•-------------•---------•---•---•--........ ------ ---- - -------------- --` - - --------- ---- �- s , -� -------- ----------------- ---------------- ---------- a = - -------------------------------------------- ---------------FINAL INSPECTION BY:_.. ------ .,__..? ------------- Date----- ----� �-�/`5-�-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wert Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2E00