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a � - , -- --- �- APPLICATION FOR SANITATION PERMIT Permit No,. --------- (Complete in Duplicate) ` Date Issue Application is here an oaquin Local Health District for a perm}/ o cons]ryct and install the work herein described. This application is m de in compliance with County Ordnance No. 549. JOS ADDRESS D LOCiATION_�ca.... %------ c..� W �," t , `4$ -----•-- ---- 771 --- --� -•--f --•-•-------------- ----------- - •= Owner's :_ ,� = a �w' -: --- 4Phone 1 --- •.-- -----�- ----•---- Contractor's Name--- _-- `...'_.�N___ ,__. - l. '_ ,zi 1 --------------- Phope i Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court Motel :;other ❑ Number of living units: ------ umber of bedrooms -------- Number of baths ......... Lot size r s _Y ----- Water Supply: Public lystem Community system ❑ Private ❑ Depth to Water Table -------- ft. , Character of soil to a depth of 3 feet: Sand P Gravel ❑ Sandy Loam a Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Mede: Yes ❑ No New Construction: Yes o ❑ TYPE OF INSTALLATI N AND SPECIFICATIONS: (No septic tank r cesspool permitted if ublic s war is available within 200 feet Septic ank: Distance from nearest wel is an rfro {oundAtlon __ Materlph t' ___ ++�� t� No. of compartments-----_.-__�1�____ . -Size, _K_ - +__�'�__-•Liquid depfh,___ T......... .--------Capacity----__ __� _.. Dispos Fish4c__ • E�'I°stan a f ari -.nearest, is an from foundationla "Distance to nearest lot line f Lai ?r-------------- Number of lines .•...... n of each line______ t__.Width of trench __ !! ` _-________-_ Type of filter maters�. '' D pth df filter material ---------X0-------Total length---- .. _----------------- Seepage Pit: Distance to nearest well---------------------- from foundation......._ ...._...Distance to nearest lot line------------------ 11 Number of pits-- -----------------Lining material-----------------------Size: Diameter.......................Depth-----.-.---------------_ ------ Cesspool: Distance from nearest well-----------------Distance from foundation_- .-..__ _-______.Lining material_ __-__---_-- __----__.__-__.. ❑ Size: Diameter-------- ---------------------------Depth--------------------------------- ------Liquid Capacity,----•-•--------------_--gals. Privy: Distance from nearest well--.____________________________________________Distance 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 ryl�s and regulations of the San Joaquin Local Health District. )(Sig - Ef. � °��.. .. �'_.... - .-__Ow�aa- sd{ Contractor ned) --------.. By:-----------------------------------------------------------------------------------------------------------------------------------(Title)---------------------------------- (Plot plan, showing size of lot, location of system in relation to wells,, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Jor APPLICATION ACCEPTED BY. ----- DATE_ y,'�` REVIEWEDBY------------------------ ----- ----' --------- - --------------------------• DATE------ w--=- BUILDING PERMIT ISSUED............... .. . --------- ----•--------------------- DATE..•._..----- -------------------------------------------- Alterations and/or recommendations ------- ----•-- - - --- --- - -----------------•-------------•--------•--•----------------------------------------------...------------. -------------------------------------------------------------------•--.---------- ---------------------------------------------------.---------.._---------. ------------------------------------ ------------ .............. r FINAL INSPECTION BY---------------1s!< ��'� / At------- 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 10-52 Revised W-2100