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APPLICATION FOR SANITATION PERMIT Permit No. _Q._ _-- it ZL Of (Complete in Duplicate) Date Issued 61 ' - Applical-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'L ATIO ------- Owner's Name ----- - ------ -_ -P--h ne--- --- a Address--- - 1 - Contractor's Name_.___ Pho ,i ---------- - ------------------ -------- ----------------- - ------. Installation will serve: Residence g�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l.-. Number of bedrooms / �I� -_ Number of baths _-____-- Lot size _ ;e! �✓- ---------- -------------- Water Supply: Public system x Community system ❑ Private ❑ Depth to Water Table�,- 5ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay p Adobe Hardpan ❑ Previous Application Made: Yes ❑ NOX New Construction: Yeo No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ptic Ta Distance from nearest well-------------- --Distance from foundation______----__________Material__----------- ..___.______-.-__-___...____-_-.-.. . ' ( r' No- of compartments-------------- ------ --Size-----•-------------------------Liquid depth.---------- ----Capacity----------------------- is i Distance from nearest well. -. -----------Distance from foundation________-.-_---__-_-Distance to nearest lot line___----________ .'7 6' � a .� Number o lines Length of each line___ Width of trench ------------------- 1 Type or filter materiai-----------------------_Depth of filter material-----------------------Total length------------------------------------____-- aq Seepage Pit: Distance to nearest well,,--K-t--------Distance from undation-,-- - ---_---_.Distance to nearest lot line---- Number of pits_____ _____________Lning li .-.._. ---_ .-Depth- CJ rn Cesspool: Distance from nearest well__---------------Distance from foundation----------_-_____ Lining material -.-----_---- -----, --------------- - El Size: Diameter- -- - ----- -- -----.----Depth------------------------- ----------- -Liquid Capacity----------- ----------------gals. Privy: Distance from nearest well----------------- --------------------Distance from nearesr building .._ 171 A Distance to nearest lot line.-------- ______________. .� Remodeling/or repairing describ _ I 4 ✓� 6 Jam. f f __�"-'� __i✓�"y`_Z"-__ "' -____ 1� �� tc --- ---------- ---------- _ - `"--Aft'--'--• _ _ _ --� _ _ _________ __________ ______ - r-- --�p I hereby certify that I hav6 prepared this,supplication and that the work will be done in accordance with San Joaquin County ordinances, a laws,10Tr I and regulation of the San Joaquin Local Health District. � �' ��;�. • s ---------- (Signed)---- --- , ----- * - ;.�' (Owner andf pr Contractor) = .. --------------------- Tale - Y (Plot plan, sho ing size o lot, location of system in relation to wells, buildings, etc., can be p*e on reverse side) ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- -- ---- ----------- - ------ - - - DATE----- ....-- . --------------------------- ---- REVIEWED BY --------------- ------------- - ------------- -_ DATE----...----------- - ----------------------------------- ---------------------------- 'JILDING PERMIT ISSUED-------------------- ---------- ------ DATE---------------- ------------------------------------------------------------ A terations and/or recommendations:_.- _--___ , ----------------- ---- - --- --- --:_----.---------_ __--�:---- -- --::-:: -------------- ------------ !- FINAL INSPECTION BY:- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M Revised W-2100