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APPLICATION FOR SANITATION PERMIT P emit No. _ --------------- (Complete in Duplicate) ,0*'' Date Issued1-4:3 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 County Ordinance No. 549. ''qq F JOB ADDRESS AND �OCION+ - y 4_.<.1(., l a��+,t ...... == Owner's Name 4._ -- Vie" ' ?e----------------------------------------------------- -------------------------------------------------- Phone---��►,l Address----------------------- ' -- ------ -------- -------•------------ --------- Contractor's Name•--- .-•-••- -'. 4op-_*... -4 - ---------------- ----------------------------------- - - -- Phone------ �----4- Installation will serve: Residence ["Apartment House ❑ Commercial ❑ Trailer Court❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ___ Number of baths . Lot size _2G � 'Q-_ __--.---------------------- Water _____________-Water Supply: Public system �❑ Community system ❑ Private ❑ Depth to Water Table -----_ ft. Character of soil to a depth of 3 feet: Sand Graver❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made:- Yes ❑' No New Construction: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: p septic tank or cesspool permitted if public sewer is available within 200 feet.) ep is an Distance from nearest well-______•-_-_-____Distance from foundation.._......____.-__:Material_______________------------------------------------------------- ❑ No. of compartments__-___ Size_________ _________ _______--Liquid depthh---__._-_____ -_______-Capacity_ ... Dis osal Field: Distance from neare�sj well__/_A2 Distance from foundation .4. _ Distance to nearest lot line....__ +� El Number of lines------•J�"-___--___-_•.___-___Length of each lin ',Q�AJA-Width of trench _._AA_- -------------- Type of filter material.:�____Depth of filter material---t-------------Total length--------1 '-4�' ............... Seepage Pit: Distance to nearest well---_------_---------Distance from foundation....................Distance to nearest lot line----------------- 1-1 _----_ ____-❑ Number of pits,...........----------Lining material_---.------------------Size: Diameter------_ _-_--- -----.Depth -------------------_._.... 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---------------------------------__--_-.-. ❑ Distance to nearest lot line-------------•-------- ----- ------------------------------------•--------0------•----------------------------------- --------- Remodeling and/or repairing (describe): 0---'------ --••------- - --- -- - -- .........---•-- --------------------------------------------- 11 ------------------------------- ------ ................................................. .............................................................. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, an ` ules and regulations of the San Joaquin Local Health District. (Signed). •. -•-- ------- ---------- ------------'---- ---- - -------- - --- -•------------ --- •--• -- -------- ----------(Owner and/or Contractor) 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 --sem--- ---- - - - ----- --- -------------- -------------------- -- DATE REVIEWED BY--------------------------- - DATE. BUILDING PERMIT ISSUED---- =------- ------- � ---- DATE �. ----------------- Alterations and/or recommendations:- ----------- ------------------------------------------------- -------- - ----- ------ FINAL INSPECTION BY: - �' 3 - ----- ---f�� --------------------------------- ,M— J�l�l 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