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APPLICATION FOR SANITATION PERMIT Permit No -- I (Complete in Duplicate) Date Issued."".&.. Application 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 OCATION...L- - -- . ..--- �.. -_ Phone�" � Owner's Name - - - Address----4-01al.... r _ --- --------------------------------------------------------- /�-� -• Phone 9 Contractor's Name.........�„!._AA----(�/ " ' '�'�'�'k -------------------- --! Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ C?ther ❑ • Number of Living units: .1... Number of bedrooms ._Xs. Number of baths ___�__ Lot size ___ _ -------s�a�� -j.<- Water Supply: Public system .X Community system ❑ Private ❑ Depth to Water Table _111W ft. , Character of soil to a depth of 3 feet: Sand❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobes 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.) Septic Tank: Distance from nearest well Distance from foundation_,_------_- Material _. No. of compartment _ --- - _Size---------------- -----• --Liquid depth __.Capacity---------- ❑ Disposal field: Distance from nearest well---1a__-_Distance from foundation-___ 4 ...Distance to nearest kot lrne_..�� Number of lines--__._-__-_ 1 _Length of each line___-_ -o Width of trench - - fi/�i Depth of filter material__.,._ "' Total length..........a#'---- -�- � ----- .r -Type of filter material. �'� � -, � - "_Distance to nearest lot line.,_ {' - Seepage Pit: Distance to;nearest well IS-0_.__Distance�from�fotu��n✓d�ation ry Number of pits-------- ----------Lining matenal_.c.T,4__,i��*/ESo' Cesspool: Distance from nearest well_____ _________Distance from foundation--------------------Lining material .-gals. F-1 Size: Diameter--------------------------------------Depth-------------------------------------- -----Liquid Capacity---------............... g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-_ __-------------------- ❑ Distance to nearest lot line------------------------------------------- _------------------------ - -------- ------- g /or g -- Remodeling and repairing (describe):- ------------ --- ) lel �_! i! --•-- ��G ._Tffi`1 l � ��r�7._7..................... p ------------------------ -------- ----- ------ ----- 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 ru `rand r Mations of the San Joaquin Local Health District. ------------------(Owner and/ Contractor) (Signed) ---- By.... . -- .(Title)----------------------------------- - -- A (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 `= - DATE � ,/ APPLICATION ACCEPTED BY...-------------------------------- ------ -- - - ,t ----- DATE---- '� -- ��------ .------ BUILDING PERMIT ISSUED -------- -- - --- .- DATE, ` Alterations and/or recommendations:------•---. -- -- ---- ----- , -- --------- .---- ------- --------- ----- •--------- .. ---•-------- ----- -- Date- -------- -- -----• ---•---- --------- ------ ------ .S W --- --- --- ............... FINAL INSPECTION BY:._..L,-:-_-?"/- - �-------- -- 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 B-51 Revised W-2100 ;