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h APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �— • Date Issued A`'pplica+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 - with County Ordinance No. 549. 7 JOB ADDRESS AND LOCATION.... ------- -pf '---------------------------------- ------------------------------------------------ Owner's Name "+� �------•-•--•----------•------------------------------------------- Phone. Address "'- ----------------------------- --------------------------------------------------------------------------------------------------------------------- Contractor's Name- 1``► ------------. ,'--------- -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- ber of bedrooms _-#�'-_ Number of baths ___Y Lot size __•_ � ?� � , -------------------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table�v ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay.-Loam ❑ Clay ❑ Adobe E?—Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ., ^ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �jTa -Distance from nearest well-----------------Distance from foundation--------------------Material____-_-____---_--_-_______________---___.______- No. of compartments---------- ---------------Size-------------------------------Liquid depth--------------------------Capacity-----------••--------- al Field- istance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line................. 111 -, Number of lines-----------------------------------Length of each line------------------------------Width of french----------•-__._____---._-.________ Type of filter material_________________________Depth of filter material-----------------------Total length.________--___-____________-_..___________ Seepage Pit: Distance to nearest well----�� __. _.__.____Distan fr`o`m„foundation---1_Q----------Dist nce to nearest lot line___J_ ______ 0� Number of pits_____ _---------___-_Lining material_ . -Yitj______Size: Diameter-__4 ------Dept h-----.1-1.4-!_______-________ 4, Cesspool: Distance from nearest well--------------.--Distance from)foundation-----_------------- Lining material-------------------------------------- 0 _-__-_-:___--_._ _.___________-.❑ Size: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity----•..•-----•------------9015. Privy: Distance from nearest well----------------------------------------------- from nearest building---------------------------------.______- ❑ Distance to nearest lot line---------------------- -----------------------------------•-----•---- ----------------------------------•--------- --•---------------------- Remodeling and/or repairing (describe)-------------------------------------------------------------------------------------------------------•--------•------•-----------------------------•- -----------------•-----------------------•--------------------•-----------------------------------------------•-------------••--------------------•--------------------------------------------•---•------------------------- -------•------------••---=---•---------------------------------------------------------------------------------------- ---------------------------•-------------•-----------------------------••------------••--•--------- ---------------------•-------------------- -------- •--- • -------------•-- ---------------- ---------•----------------------------------------------------------------------------•--•------•------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of thejoells, uin Local Health District. (Signed) ------ °> r_. - - v7nsr-andf or-Gontractorj - TO5 ,,�__.. -- itlePace(Plot plan,sftowing size of IA91 �`�itystem in relatbuildings, et ., can be reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------------- N------------ ------------------------------------------. DATE ---------- ------------------------------------------- REVIEWED -- - ------ -- ------------------------ RbVIEWED BY - _ DATE •.•- BUILDING PERMIT ISSUED----------------------------------- 4-� ------------------------------- ----------- DATE- ----------•- ------------------------...... Alterations and or r c mmendations: `'~ _____. - � ... --------------------- ---- - ---- --- ------- --------- ------------------------------------------------------------------------------- FINAL INSPECTION BY:----C •• ------------------------------------------- Date.-- -� — ---- - --------------------------------------------------- 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-9-2M Revised W-2100