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.y -�� APPLICATION FOR SANITATION PERMi " - Permit NooS (Complete in Duplicate) x J_ ( Date Issued t ! a 4Application 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 wi C y Ordinance N . 549. JOB ADDRESS AN OC TION--- -..-• ---------------- --- ----- � -•---- - Owner's Name ------ ------- ------------------- Address ----------------- - Phone �+ j .._. Address_...-s�.t.- •-____ -- -----• ------------------------- -------- -- = . ' Name------ ------ ------ -------- -- ------------------------------------------------ .......................... Phone--------------------------------- Contractor's ., lWallation will serve: Resident Apartment House [3 Commercial ❑ Trailer Court 171Mo } ❑ Ot t ❑ Number of living units: _.1-_:_: Number of bedrooms _Z_ Number o aths ___/_: Lot size ...................... F Water Supply: Public system-❑ Community system ❑ Private Depth to Water Table ----- ft. Character of soil to a depth of 3 feet: S;�ONew Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan Previous Application Made: Yes F1, No Construction: Yes o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' esti nk;' Distance from nearest well-----------------Distance from foundation....................Material____::_________ __.,�___ _--:_- __- UNWVW� No. of compartments Size Liquid de'pt ----_--= ` . gisp al Fi Distance from nearest well_ Distance from foundatio _ _ istance to nearest 1 1' . Number of lines__. �/ _________ Length of each line _____ �t_.Width of trench_ .. Type of filter materia 1t7pth of filter material_:_.____.: _>.__Total length___________ ______ ___._____ .,.. Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line............... ., s. ❑ Number of pits----------•----------Lining material-----•-----------------Size: Diameter.--_..:- -_----____-Depth ----•---- ----------- Cesspool: --- ---Cesspool: Distance from nearest well :______________Distance from foundation_:_-_ ............Lining material................................... ❑ Size: Diameter----------------- ----------------Depth--------------------------------------------------- Liquid Capacity ----•-- -----.-----ga Privy. Distance from nearest well__________ ____________________________________Distance from nearest building------.......:._____ ......... ❑ Distance to nearest lot line------------------------------------ -----------------------------------------------------__- -------------------- tib Remodeling and/or repairing ( escribe)_------------------------------------------------------------------------------------- ------------ --- ------ - — I------------------ ---- - he y rtify that I have prepa d this appli ' n and that t work w 1 done in actor nee with San .loegttin . ordinanc , State laws, and rules and regulations of the San Joaquin Local He h District. ___-. ._Owner and/or Contract (Signed):_:%`-- --�1___�1_- % ------ By: ( / . --------------------------------- ----•----- ---- ----------................................ ----- ----•--- (rte)............................................................. (Plot plan, showing site of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY-- -------------------------- ------ DATE_S REVIEWEDBY-------------------------------- ---- -- --•--•-•--------•--•----------------------------------........................ DATE ' ---------------------------------- BUILDING PERMIT ISSUED--- - �.t�-----� --- D - ------ .... Alterations �d fr o m ations: � !l.Pt._+Lu,. � ( ----- -•---•--- - ------------- -- -----------•. •-------------•-- --------. .........-----._... ...................................... = ----------------•-•-----------------------------•-•--- .--------•-----_-----•----- --•-- -••---........ - --- --------- --___ --------------- -------- ------- -------- ----- -------- --- --- FINAL INSPECTION BY:--- -- -........---:- -. Date...... 1 --— ...'� 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 is ES-9-2M 8-51 Revised W-2100