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Avow "k V� • APPLICATION FOR SANITATION PERMIT Permit No. X!"// h` (Complete in Duplicate) Date Issued �.._/ !�" . Application is hereby made to the San Joaquin Local Health District fora.permit to construct and install the work herein described. This application is made,in compliance with Coun `Ordinance N"49 16e / JOB ADDRESS AND LOCATION f rR _1_/- Owners Name - �� . pp / / 5 ---------- Phone_s�."_37 Address ..f3__f `' - 6_f ---------------- - ---- --- --------- ----- Contractor's Name. �f..�r` r /_LSA? S ff2L1---------- Phone-- `s' �� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑- Motel E] Other ❑ Number of living units: --1-___ Number of bedrooms;7%_- Number of'baths _-f_,_- Lot size ------6.01-------&J_6 ©-------------------- Water Supply: Public system ❑ Community system ❑ Private JC Depth to Water Table _"_t/eft. Character of soil to a depth of 3 feet: Sand F1- Gravel ❑ Sandy Loam ❑' Clay foam ❑ Clay❑ Adobe- Hardpan Previous Application Made: Yes ❑ No X, New Construction: Yes ❑ No ❑��t' / , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within200 feet.) ePbj: T Distance from nearest well Distance from foundation _.. ____.Material _._-__-- 44 - No. of compartments--------------------------Size-------- -----_-I ---------Liquid depth--- -------- Capacity----_--------------- Distance _---- -------- Distance from nearest well----- Distance from foundation•_.•.--._- .-__-__-_Distance to nearest lot line----------------- Number - - --_--_-_: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__&rte-___-_-----Distant #.r f undation._�s � ;.Distance to nearest lot line..._..�.. Number of pits__ t_____________Lining materiaE -____Size: Diameter_ 61 -`_- ......Depth_..:�_a5................... Cesspool: Distance from narest well-----------------Distance fror`l-foundation----------........Lining material ------------------------- El ____-__._ ---_-_.❑ 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 ave prepared this application and that the work-will be done in accordance with San Joaquin County ordinances, Slate laws, rules and regulations l6f the San J4aquin Local Health District. (Signed) :-..-t-- -• ----- ?- - - +� -- -------- ---------------------LgaContractor) By:_- '`--------- - --- k ----- ------------------- -------- -----_--- ------...(Ti+le) `" . !�"1?f; . �! ' --- ---------' (Plot plan, , wing size of lot, location o system in relation to wells, buildings, etc., can be:placed on reverse side). FOR DEPARTMENT USE ONLY y APPLICATION ACCEPTED BY----------- ---- -- -- ------------------------------- DATE------- REVIEWED BY-------------------------------------------- ---------------------------------------------------------- - DATE ------------- BUILDING PERMIT ISSUED--.....................--•--------------------------------------- ----• ------ DATE ----.--- _--- --------- Alterations and/or recommendations:--------------------------------------------- Cc FINAL INSPECTION BY:. -----------_ _------- -------------- 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 8-51 Revised W-2100