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�! APPLICATION FOR SANITATION PERMIT - it No. ./ l . -�T'� ` (Complete in Duplicate) S ye Date Issued ... .?-O�S� Application is hereby ade to the San Joaquin Local Health District fora permit to c nstruct and install the work herein described. This application is made in compliance with County Ordinance No 549. / JOB ADDRESS AND ATIO --------- -- .-- ---�......-•---------••----••--•--•--- �./. .-- - .. .--=-- •• ------------------------------------------- Owner's Name-------- ------- ....... - - ---- -----------/'--'---------------- ------ Phone-- -: ------------------ Address------------------- -- •. ----------------- --••----------- •... --•---•-----------•-----•--...-- ------------------•--------...................... Name......................... :_ Phone.. cam' -s' Installation will serve: Residencelx Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _v_,2__ Number of bedrooms.,_ Number of baths__ Lot size ----.1..:5�_.,Y._.�e___---_________________ Water Supply: Public system ❑ Community system ❑ Privateje Depth to Water Table . 1D_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑l Previous Application Made: Yes ❑ Nob New Construction: Yes F] N r TYPE OF INSTALLATION AND SPECIFICATIONS: I (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. _____:__::_:_.- _._-.--.-__-•__No. of compartments----------------_------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field:/ Distance from nearest well-----------------Distance from foundation___-_•_.___-_----_.Distance to nearest lot line-__:____•--- )Ex 4T,/ "4 Number of lines________________________________--Length of each line------------------------------Width of trench-----------------------------------_-_ Type of filter material-------------------------Depth of filter material----------------------- length--_-___--__-----_-_---•_--__---_--__-___-- See a e Pit: Distance to nearest ell__1aa_________Distance fr m fou ation.__,/0...___.Distar9ce to nearest lot line Number of its_ - )-___-_-___Linin material Size: Diameter___-- __-_-_Depth----__ __' ' ` P g •- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material.-------------------------------- 171 -•__ -_-.----_ . _- -----❑ Size: Diameter--------------------------------------Depth.---------------------------------------------------Liquid Capacity----------------------------gals Privy: Distance from nearest well------------------------------------------------- from nearest building---------------..........----_.__-.-__. ❑ Distance to nearest lot line------------- -------------- -•----------------_----------------•-----------------------------------•---•---•-----•--•----------•-------- Remodeling and/or repairing (describe)-------------------- --- - --- ------..------------------------.......................-...............................................----------- --------------•- ----••-•---•. ---• ------ ------------- -- ---------- --------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawEKE, tions of th an Joaquin Local Health District. ----------------------------------------------------- Owner and r ontractor (Signed)---------------------- ---- --- -- - ----------- ) �By. _..--- -- ----------------------------------(Title)--- ----- - ---------- - -"-(Plot plan, showing sistem in relation to wells, buildings, etc., can be p on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... -------------------------------- _____ DATE"'. REVIEWED BY----------------------------------- ---- -------------------------------------------------------------- --•---------------DATE...`, ,*------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------ ------- ----•---------------------------------------- DATE.---- .1�� Alterations and/or recommendations:------------------------------------------------------------------------ =: ----------------------- --------•-------------------------••.... -----------------------------------------•----------------------------------------------------------------------- ------------------------------------------------------------------------------ ------------------------. --- ----------------------------------------•- .- ------------- ------------='=----------- ------------------------------------------------------------------ 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 10-52 Revised W-2100