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q APPLICATION FOR SANITATION PERMIT Permit No. ._.-lam (Complete in Duplicate), Date Issued �3 Applica{ion is herebi made:to theSanJoaquin 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 LOCATIONi-- ------ _!-�------ �__�"'_ Owner's Name------------ t�_dnk------ -------r�--�-a'------- ------------------------------------------------------- ------ Phone_---d°P,?,c,g- Address-------------- ' '? - -------- Contractor's Name. _I�1�.1 S _ ------------ --------------------------------•-------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number,of living units: ___,✓Number of bedrooms __- Number of aths �___ Lot size ___,�� ------ -----r--'------- -- Water Supply: Public system ❑ Community system ❑ Private epth to Water Tableft. Character of soil to a depth of 3'feet: Sand ❑ Gravel ❑ Sandy Loam-E] Clay Loam ❑ Clay ❑ Adobe Hardpan 1:1Previous Application Made: Yes o I] New Construction. Yes E] No E] 4 TYPE OF INSTALLATION AND SPECIFICATIONS: _ 40 '� }(No septic tank or cesspool permitted if public sewer is available within 200 fee Septic T Distance from.nearest well_____Distance from foundation____l_t`S- _.Material____________________________ __ _ No- of compartments____-___ Size_ Z- __ ----�_Liquid depth___ }- ---_Capacity _ .^- .. �. . s 6 31 ` p P Y a1------- Disp�osal/F`'�ld: Distance from nearest well_ ------�Q_ __ "Distance from fou dation__ _o Distance to nearest lot line______-s LY Number of lines------I------------------ -------Length of each line - •---------.Width of trench----�'r�L Type of filter material-__�;l'`- Depth of filter matenai-----�$_-..........Total length--------' Q - Seepage Pit: Distance to nearest well@_�_ fd ____-_Distance fro ouna _ __ tion_- --------.---.Distance to nearest lot line______ _-_ Number of pits--_Z----- ________Lining' material_ �___:S Size: Depth-. ---- ------------------ Cesspool: i•-- ------------- Cesspool: Distance from nearest well-----------------Distance from founfdaton-------------------- Lining material------------------------------------- El Size: Diameter----------- ------------ ----------Depth-----------------------------------------------------Liquid Capacity-----------------==-------gals. Privy:• Distance from nearest well-___________________________-___--___-_-_-------_Distance from nearest building____--___-_____--____ ❑ • . ------------- Distance to neares# lot line___.__:______________ ---------------- -------•-------------- --------------------- ---------- Re o eling nd/or rep';rIn scribe):___ ------------------------- •--•-•------.._..r— -- "_ _ rc -- ------- ---- - ---------- --------------------------------- ............................................................= ----- I hereb ify that hhave,prepared this application and that the work will be done in accordance with San Joaquin County ordinances, q4afeN.ws, and r les and regulations of the San Joaquin Local Health District. Si ned � ( 9 I (mss' L Contractor) By--------------------------------------------- - -( [Ti - tis (Plot plan, showing size`of lot, location of system in relation to w li buildings, etc., cyan be placed on reverse side). FOR DEPARTMENT USE ONLY 11 APPLICATION ACCEPTED BY__--- DATE Y = ---- IEWED BY ---------------------------- --------------------------- ---- -- ---------------------------------•-------------------- DATE----- - • --- BUILDING PERMIT ISSUED_. `-------------------------------•------ _ DATE.---- --- ---------------------------------- Alterations and/or recommendations___________ - -------•--`- •----•----- ----------------------------------•------••------------•---•-•---------------- .--• - --------------- ----------•----------------=------------------ -- --------------•-------•------------------------------•-------------------- -- - - Aoe FINAL INSPECTION Date------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+ree+ 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100