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r APPLICATION FOR SANITATION PERMIT Permit No _; .a�.� tete in Du irate _-- (Complete p � j Date-issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein clescribe4,,,-„� } This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-._J'A/ ---------l, .______. �-f'�t------ ------ --- Owner's Name J ,'4-4.- .J ------------------------------------------- Phone Address --------- r�__ �.w. ------------------------------------------- ----- Contractor's Name---- is-. 01. ------------------- ............ Rhone Installation will serve: Residence Apartment House,❑ Commercial F1 Trailer Court ❑ Motel ❑ Other ❑ .y Number of living units: ---/_ Number of bedrooms _a?i__ Number of baths../--- Lot size .....1-4 (� �f .-------- Water Supply: Public system ❑ Community system C❑ Private Oe Depth to Water Table ft. Character of soil,to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ClayLoam Clay❑ Y ❑ Adobe[Hard pan [�`� 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.) S pf is nk' Distance from nearest well----------------`Distance from foundation....................Material_ No, of compartments. - Size--------------------------------Liquid de Capacity .......... - Dispos Fi Distance from nearest well-_-7_ Distance from foundation___- _�-.Distance to nearest 1 I�r - ----------- _-- EZ Number of lines._ Length of each line___.--. j• � Width of trench.__ `" ' t`. Type of filter material._. -_..___:_Depth of filter material .-._._ _ �} . _Total length-.--.-��L[................. Seepage Pit: Distance to nearest well- -----_-_--- ` .__Distance from foundation--------------------Distance#o nearest lot line...............�. ❑ Number of pits---- --------- Lining material--- -------------SizeDiameter-------- ---------.Depth----_--------------- Cesspool: --._----- .-- - Cesspool: Distance from nearest well_--.---_ __-_.Distance from foundation---------- Lining material... ._....... ❑ Size: Diameter---- ------- - Depth------------------ •- Liquid Capacity- - -------g4►- Privy: Distance from nearest well Distance from nearest building--------:------- kg--_----------_----------- ---------- Distance - . . , ❑ to nearest lot line --------.-- Rem ling rd j r repairing (d c�ibe -bltl ------------ r - -- ._.. . _ . ... - *#t- ----•--- -------- --------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou* ordinances, State laws, and rules and,regulations of the San Joaquin Local Health District. - (Si ned 9 ) ---- -----•-- - ----- ---------(Owner and/or Contrac By -•--- ------. •----•--- Title (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 APPLICATION ACCEPTED BY - = ' .- . _ - _ DATE__ REVIEWED BY-- ---- _.._ - DATE-_ BUILDING PERMIT ISSUED _. -__-_. _ - -- � �, / ------•• -. -.:_ ----- -------- -------- DATE Alterations and/or recommendations:--- _.- A, ----- ---- -------- --•------ ----- ----•---------- -- --- 9�,! ( STs � a_. r £ Le�lQ� 1'\ -.c-, of l 1rS XA {� Sm. _, ----- ----------- 5. -- rpt h"!✓� '. ._. 4 �t AM��4l� l1fi- FINAL INSPECTION BY:. ---__- Date __ _ -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreof 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