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APPLICATION FOR SANITATION PERMIT Permit No- ------ ------------- 1 (Complete in Duplicate) Date Issued Applical-ion is hereby made to the San Joaquin Local Healf District for a per to con ruct and install the work herein described. This application is made in compliance with County Ordina e No. 549 - /® - �-- ------------ ------ JOB ADDRESS LOCATIO -- - ---------------------- - ---- - Phone/.. Owner's Name � � '� Address----- - --- ---- - E-- ----------------------------•-------^ Contractor's Name--- - ' ----- 1-------•-• -- ._. Phone -,?.:-/-z /`�. Installation will serve: Resi encu Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other '❑ Number of living units:__ Number of bedrooms- Number of baths ._ Lot size ------- Wafer Supply: Public system El Community system ElPrivate Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand F1Gravel El Sandy Table-'?!5?Table-'?!5?Loam ❑ [IE]Clay Loam Clay Adobe❑ Hardpan Previous Application Made: Yes ❑ No New Construction: YeA No ❑ TYPE OF INSTALLATION AND SPECk (CATIONS: -jNo septic-tank•or-cesspool-permittedrif-public-sewer--is-available-within-200 eet. — --=~--�-- ptic Ta k: Distance #rom nearest well Distance from foundation_ Material________________________________________________ No: of compartments----- ---Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Fie „Distance from nearest w IU Distance from foundationto____-_-___.Distance to nearest lot line- _-.-_____._ Number of lines---/----------------- Length of each line_________ -5-to �__._r___.Width of french----1�-- ___.__________ Type of filter material Depth of filter materia .--__Total length________- .____________________ .�'�---- -L.. 7. _ ,... Seepage Pit: Distance to nearest well______________ _------Distance from foundation__ -------------Distance to nearest lot line----------------- Number of pits.----rI--------------Lining material---------------I-----..Size: Diameter-----------------------Depfn-------------------------------- /• Cesspool: Distance from nearest well-----------------Distance from foundation___--,.::.__.._____.Lining ❑ material__._____.___________.________________ Size: Diameter Depth----- -- - ----k---••------- ------------- _Li Liquid Capacity ---gals. , � --i-Distance from nearest buildin Privy: Distance from nearest well----------------------------- g - Distance to nearest lot line-------------------------- ------ --------••---------------------=-------------- �------------- - ------ - --- Remodeling .and/or repairing (clestribe) ___ r ___. _ _ - • - ------ -� ` -- -------- --- '---- ---_-�`�'_.- _---------- --------- ��¢ ' ' .>:' -- ----------------------------•-------- --------- --- - ----------------...---------------------------- -- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that l have prepared this application and that the work will-be done in accordance with San Joaquin ounty- ordinance fe la a rules and regulations of the San Joaquin Local Health District. ---------=----------------------------------- ------ •-------- (Owner and/or Contractor) (Signed)-- - - -- - ...----'-- ---- --gY��---- •i- --•�` ----•�-------------------•-----�---------��-T------- - ... _ _ ,r .-Title).' - � � ------------------ ---- -----••-•---- (Plot plan, sho insize of lot, location of system in relation to wells, build ings, etc., can be cad reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATION ACCEPTED BY- ---------------------------------------- DATE-------- ----------- --------------------- € �. ------------------ REVIEWED BY------------------------------- ------0-- - --------------- ---------•---------- •--------------------•------• DATE------- -"---��- ��--- --�---------------------BUILDING PERMIT ISSUED--------------- --------------------=---------------------------------- DATE..--/----- -----------------------------------•- Alterationsand/or recommendations--------------------------------------------- --- -------=--•---------• ------------------------------------------------------••------•------------------- ----- --------- ----- --------------------------------- ------------ Aiv --�--- ------------ ------------------- ---------•-----•------------ ------ --- FINAL 'INSPECTION BY:--------= =' = --------------------------- - 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, California ..ES-9--2M4 Revised W-2100