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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / -,Data Issued ---9 °/ `a Applica+ion 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. JOB ADDRESS AND LOCATION-------- ---"_ -"- -------- --------- i y,� 1 1� f Owner's Name--------`!/ •crp.� 11�fJ 7 d - -- Phone _ -- -- Address ------------ Contractor's `-'2. Contractor's Name___________________ __ - - - --------------- Phone/ Installation-will serve: Residence Apartment House [] Commercial [❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: ___4_ Number of bedrooms __oZ Number of baths ___/__ Lot size _ .-- k ------------ Water Supply: Public system Community system-El Private [-I Depth to Water'Table _/X/d ft. — # Character of soil to a depth of'3 feet: :Sand Gravel ❑ Sandy Loam ❑ Clay L ml❑ Clay El Adobe F]Previous Application Made: Yes E] No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: Y (No septic tank or cesspool permitted if public sewer is oval le within 200 feet.) Septic T k: , Distance from nearest 'well-----------------Distance from foundation__________________Material__.___________-._______._-____._____-_________. i of .. P q P.h = Capacity ------------ Disposal Field: Diosfance from rnearest well__-..,-------_Distance from foundation Liquid de t Distance to nearest lot line._____--------- ❑ i� Number of lines... = ---------Length of each line------------------------------Width of trench Type of filter material_________________ *'! Depth of filter mafieria------------------------Total length------------ ---------------------------- Seepage Pit: Distance to nearest waif_. —~__---"Distance fern oun ation__--_v_"a-`_-.Disfanie to nearest lot.line__._�l Number of pits._____.------------Lining mate ria L�_ CX4<4Size: Diameter_-.___ ---- Depth------Oz Cesspool: Distance from nearest well-----------------Distance from foundation--- material__.________________------------------ , Size: Diameter--------------------------------------Depth----------------------------- ------------- Liquid Capacity- -----------------------r--gals. Privy: Distance from nearest well--- ______________Distance from nearest building_ j _ Z. D�stanca'to nearest lot line___________________ ---------------------------------------- r Remodeling and/or repairing (do scr;be :_____ S -------------------- ----- ----/ r -- ------ -- ---- --------------------- --------------- --------------------------------I------------------------=----------•--------------_---- ----- --- -------------- ordinances, certify laws,-that I haVG' and r regulations as plicate San Joaquin cork will be done i--.____ "_. ____ _"______an _____________ _____""�County - ---------- ate rules Y y 'n accordance with San Joaquin County q al Health District. (Signed)-------Ll---;------ f ti --------- --- ---- -------------- ------------------------------------r----------------- -- r and/or Contractor) By:......... {Title) Pot plan, showing sizes of lot, location of system in relation to wells, buildings, etc.', can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - t �. DATE . ------------------------ Y ------------- ----------------------------•- REVIEWED BY ------- -------- -- DATE BUILDING PERMIT ISSUED --------------- - --------- --- ------ - ---- DATE----------------- -------- Alterations and/or recommendations:_________. - --------------------------------- ----------------------------------------------- ------------------. -- ----- ----- ---------------------------------------------------------I------------------------ - ----------- - ` --------------- FINAL INSPECTION Date. ✓ - -� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100