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APPLICATION FOR SANITATION PERMIT Permit No. 3a`... (Complete in Duplicate) . litDate Issued ..______---�-•------ Application is herebymade to the San Joaquin Local Health District for a permit to construct and install the work herein described/ This application is mde in compliance with County Ordinance No.X54/9. JOB ADDRESS AND LOCATION ---e ------------- ta/.. -. [ --------1�-- f -- ' Phone-,_ _:.A��-�----- Owners Name---------��.E-�-----------�---------- ---------------------------------------------- Address------------- --------------------------Address------------- -------- -------------------------------------------------------- Contractor's Name ! w d ----------------------------------- Phone_F=-?6 -------- Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4t1/6Number of bedroomsl"_ Number of bathsd#d—Lot size Water Supply: Public system X Community system ❑, -Private-[:1 Depth to_Water�Table .1/ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- No. ....---- ....-__------._-_-....__.....__-.._... No. of compartmenis--------------------------Size-----:--------------------------'Liquid depth--------------------------Capacity-------------------- vTv x line - Dis o a[-,Fil : Distance from nearest well-----------------Distance from foundation-------------------- to nearest lot ___.___....._.... p ' Number of lines-----------------------------------Length of each line------------------------------Width of #rench----------------------------------- Type ---------------- ---------------- Type of-filter material-------------- --------Depth of filter material-----------------------Total length-----------------------`---------------- See a e Pit: Distance to nearest well../_aYO?�--_Distance from foundation_ Distance ce toI]ea{est ine---9_�_----- Number of Liningmater�al _��_I_� � .Size. Diameter-,?. p Cesspool: Distance from nearest Well ___....-r------Distance frorri foundation....................Lining material--------------------- ---------------- ❑ Size: Diameter------- -----------------------------Depth-------------------------------------------------- Liquid Capacity gals. I Privy: Distance from nearest well--------------------------------------------=----Distance from nearest building------------------------------------------- Distance -------------- Distance to nearest lot line--------------------------------------------I-,--- - ------------------------------------------------------------------- ----------------------- Remodeling and/or. repairing (describe)=------------r--_------------- --------- ------------`------------ ---------------------------------------------------------------------- XX-AIN------ ----------- 1.'S.T`1_IV6- --------- . -----------------------------------------------------------------------I-----------I--------------------- --------------------------------------------------------------•-----------•--------------------- ---------------- ---------- -------------- ------- - ------------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------- 1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and rules and retoul` tions of the San Joaquin cal Health District. I---:SW - -(Owner and/or Contractor) (Signed) _ ------ -------�=---` f / BY' F �C �`"'"� --- -- buil ----- (Title) _ .., - - .� - - (Plot plan, showing size of lot, location of system in relation o dings, etc., can be placed oa reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ----------------------------- ------------------------------------------------------------ DATE REVIEWED BY------------------------------- - DATE _ - - ------------------------------------------- BUILDING PERMIT ISSUED----------- -----------------------------------D--A- TE----------- ----------------------------------------- ---------------------------------------------- -------------------------------- Alterations and/or recommendations------------------------------------------------------- -------------------•------- ---------------- 7 -'---------------------------------`------------`-`"'------- � 1 f ' FINAL INSPECTION BY:-: !l-.N=---- -------------- Date...._.' IC ._`_`S` -- SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 9-51 Revised W-2100