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`7 APPLICATION FOR SANITATION PERMIT Permit No. 5. ......... (Complete in Duplicate) _ I �� (' 4�1 O Date Issue dI ..App ica�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 LOCATION-..,9I�s - L�,r�..----------• -- Owner's Name LLJ J._ ------ --J------------------------------------ Phone-------------------.. Address------------•-- -.. .....•--•- --------•--- -- ----••-•------•--••••------••--------•---------•....-------••---•----------•--•--•-••---•..... . -- •• ................ Contractor's Name - --------- ----------- Phone•- � �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Traile Court ❑ Motel ❑ Other ❑ Number of living units: __�____ Number of bedrooms __Y Number of baths ---7 Lot size ........ ................. Water Supply: Public system GROCommunity system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[P-14ard n ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) b-poc T aq k:,-.,_,.,.^.._Distance from nearest well-----------------Distance from foundation....................Material-------------------------- -No, of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- osal Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. Number of lines___________________________________Length of each line........._--------------------Width of trench-------------------................ Type of filter material-------------------------Depth of filter material-----------------------Total length..__....__._.._•...._...___...•�..•...-_-_-�� See age Pit: Distance to nearest well_`' -------Distanc wfr ,fo�fdation_I� _r ist c�,fo nearest I line__.___v�.____. Number of pits----f -------------Lining materiaf�!�% Size: Diamet1_':-,(1_;_0r_.--.---Depth------- ,7�.......-....... 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------------------------------------------ r_1 Distance to nearest lot line-----------------------------------------------------------------------------------------------...... Remodeling and/or repairing (describe) ------ ---------------------------------•-----•--••----------------------------•-------...--------------------....---------------------------•--. ------------------------------------------ ------------------------------------------------•------------------------------------------------------------------------------------------------------------------ I hereby c t I have pre=re * application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws, a rules anns of the San Joaquin Local Health District. (Signed)------------- ----1r . . .-- ------------------- ---------- -------- ------------------------------ Tdon (Ownep'wdicr Contractor) 1 By:._...•••---------•........................... ----•--- ------= --------------------(rile)--- tet.•-— 7!-x.2------=------------- (Plot plan, showing size of lot, locatim in re ' n to wells, buildingstc., can be plareverseside). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - -- - -- ------ ---------------------------------------------------------- DATE------..ter-.....................----------------------- REVIEWEDBY-------------------------------------- ----------- - --- DATE---------------- . ----- ---------------------------------- BUILDING PERMIT ISSUED......................... DATE...................... Alterations and/or recommendations______ .........................................................._ __________ . %J•.-•--------------------- ------------------------------------------.....................................................----------------...�.---•------------ ............------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- FINAL INSPECTION ------------------------------- 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 ES-9-2M Revised W-2100