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APPLICATION FOR SANITATION PERMIT Permit No. '(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. �r,� a JOB ADDRESS AND LOCATION__ _v_�-�__- -- "`� 11" /0� f / 1- - ---------------3 �- en-�-------W Owner's Name - _� -.f�_ -f--------- �-4 -A ----- Phone-- ------------- hone--�-�Q - - -------------------- Address � ----------- -- ---------------------------------- ----------- Contractor's Name--------------------- i !-- -------------- '` '� Y Phone------9!7- Installation will serve: Residence Apartment'House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ ! Number of living units: -4— Number of bedrooms __2�'Number of baths _0----- Lot size __ --- _ ____________________ x Water Supply: Public system ❑ Community system ❑ Private] .Depth to Water Table�1?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay,❑ Adobe' Hardpan ❑ Previous Application Made: Yes ❑ N0 New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: -'s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic=Ta k: Distance from nearest well_________________Distance from foundatiori____________ --_='Material__-___________ --------------------------------- �� No. of compartments--------------------------Size--------------------------------Li Liquid de th----------------- q P Capacity.... ----- v c ID bsal Field: Distance from nearest well-----------------:Distance from foundation--------------------Distance to nearest lot line_______-_______-_ 1�^"] Number of lines-----------------------------------Length of each line_______________ -_.---______-Width of trench ! -------------- - f Type of fitter material-------------------------Depth of filter material-----------------------Total length--------------------------------_-- /� ------ Seepage Pit: Distance to nearest well-10-9-7--------Distance from foundation_�0..........Distance to nearest lot line_/©"__ Number of pits_ ]Lining material_ 444-Size: Diameter_____ f'---_.Depth---- -AX-0------------------ 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)_----------------------_-.--------------------------------------------- --------------------------------------------------------------------------------------------- ------- ---------------------------------------------•------•- ----------------------•--------------------------------------------------------------------------------------- - ----------------- T I hereby certify that I haws prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules "and regulations f-4h Joaquin ,ocal Health District. , ned {) (Sig )- ----------------------------- r (® or Contractor) ] B lei+... Ti+le_ --------------------------- - (Plot plan, Ing size of lot, location of sy�intionto wells, buildings, etc., can be g praced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE-5 --•----------------------------------------------- UIL WED E I ------ DATE- ;<_�--- UILDING PERMIT ISSUED --•--------------------------------- - -------------- DATE----------- - ------------------------ Alterations and/or recommendations:----------------------__---------------------------------------- ----------------------------------------------------------- ------ ----------------•------------------------------ --------------------------------------------------------- FINAL INSPECTION BY:--------- -.11 � Date ------ --- --- ------------------------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT r 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