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APPLICATION FOR SANITATION PERMIT Permit No. ... . 1, (Complete in Duplicate) Date Issued A .. Application is hereby made to the San Joaquin Local Health District foraermit to This application is made in compliance with County Ordinance No. 549. p construct and install the work herein described. JOB ADDRESS AND LOCATION............... . lid poe ty . Owner's Name----- --- r -- I f _ - Phone �' I' Address Nr2Gf� �(�' -' fix` -,e ---- ------------------ Contractor's Name -- - /--- ----- ----------- ------------------------- Phone......(_ Installation will serve: Residence ❑ Apartment House �] Commercial ❑ Trailer Court Motel El Other El___ umber o wird Number of living units: // Nr rooms -------- Number of baths -------- Lot size __a� Water Supply: Public system j< Community system ❑ Private ❑ Depth to Water Table e9ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan {� Previous Application Made: Yes No New Construction: Yes E] No ❑ �Qm nil, , TYPE OF INSTALLATION AND SPECIFICATIONS: lop / jz+�• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N Septic Tank- Distance Distance from nearest well_•______________Distance from foundation___.--_ ..____-_ _.Material_______._-_ IC—tJltr'1 No. of compartments---- ---- ------- ---Size --------Liquid depth--.------. --- --------Capacity --- -- --- Disp al F' Id: Distance from nearest well �b1 „1-_Distance from foundation.�� .____.Distance to nearest lot line-__�_t _f.. Number of lines......I-___--_ _ __ --------- ---------------- of each line-- Q-----r�---._.Width of trench.cz ------------------------ 4 �l Type of filter mate ria l_11�_ak__-_Depth of-filter materiaL___:1�__-___._Total length--------&Q----------------------- Sewage it:, Distance to nearest well_ 40AA,.,-------Distanc fr fo ndation__� ----._-:D' Lance to nearest lot line__ � �� Number of pits -----------Lining materialC ' + � Size: Diameter_ �r. Depth "� ` ------------- Cesspool: Distance from nearest well-----_-----------Distance from foundation--------------------Lining material._____::_____--____-•-______ ❑ Size: Diameter--------------------------------------Depth--------------------- ------ ---.._Liquid Capacity--------------------------glis. Privy: Distance from nearest well -------------Distance from nearest building ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------- -------------------------- ------------------------------------------------------------------------------------------------- _.. ,1=----------------------------------------------------------------- - ------------ ------------------------ ----------------- ,.--------- - --- - ----- ------ --- -- ------ -- ------- ----- ----- ------ --- I hereby certify that I h ve pr pared this application and th`t the work will be done in accordance with San Joaquin Coun t► ordinances, ate laws, and les a ,regulations of the San uin Local ealth District. (Signed)--------- -------- - a - - ontractl - r /> BY: -- - L------ ---(Title) �G1 1( �l (Plot plan, showing size of lot, location of system i�"relation 1 ells,'buildmgs, et ., can be aced on reverse side). F PARTMENT USE ONL APPLICATION ACCEPTED BY------------ G - ---'------------ ----------------- DATE---r -Z / �2 ------- REVIEWED BY -_----------------------------------------------------- DATE------------------ -- UILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE-------------- 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