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Permit No. __-!=�� f APPLICATION FOR SANITATION PERMIT -1 -- .. .. w s3 (Complete in Duplicate) Date Issued - 1 pplication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinanc No.X549. -- ----------- -------------------------- JOB ADDRESS AND LOTION--------- -U -- --- ------------------------------------------------------------ --- - Owner's Name--- __ -.. ---*------- ---- - ----------------------- -- --------------------------------------- Phone----�- Address-------_--- --- ----------------------------------------------------------------------------- - ----------- ------ Phone-?-- Contractor's Name------------------------ - ---- ❑ Installation will serve: Residence,, Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �._ Number of bedrooms-- Number of baths�_- Lot size -----I-&X f-�� -------------------- Number of living units: __ Water Supply: Public system' Community system ❑ Private ❑ Depth to Water TabQ le� ft. Adob Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel F1 Sandy Loam 171 Clay Loam ❑ Clay ❑ Previous Application Made: Yes ❑ No New Construction: Ye�No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Liquid de th--------------------------Capacity----------- 1V - ----------------------- Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--------------. . . -__ _ �� No. of compartments - Size q R Dis osal Field: Distance from nearest well_________________Distance from foundation_._.---...__- -_Wldthcoftfrench est lot line__=:____-.-----_ p r ��,y C� Number of lines___________________________________Length of each line.._:_...___.------- Total length p �f ..._.Depth of filter material--- 9 �7 Type of filter material___________________ p � .__Distance fr oun tion__---sS7---.__.Distance to nearest lot line._._------- See a Pit: Distance to nearest well_'?' _ Size: Diameter-------- `...._---Depth------ -------------------------- (A Number of pits---- Lining materia Cesspool: Distance from nearest well-----------------Distance from foundation__ --___----------- ning material El Size: Diameter---- -------------------------------Depth--------------------- --------------------------- Liquid Capacity Y---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.--------------------------------- W ❑ Distance to nearest lot line-------- ---------------- -----------------------"------- ---------------------------- Remodeling and/or repairing (describe)_________________ ----------------------------------------------------- -------------------------------------------------------- / ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County „ ordinances, State laws, d rules nd egulations o e San Joaquin Local Health District. I-C Owner and C tractor) Sined - ---- ------------------------------ ------------- ---------------- --------- ( 9 -- Tale BY� r •------------------------------ -------------------------------- ( � ) (Plot plan, showing size ot, location of system in relation to wells, buildings, etc., can be pl4xon reverse si e). O TMENT USE ONLY APPLICATION ACCEPTED BY f ------------------ DATE BY-------------------------------------------- ----------------------------------------------- ----------- DATE------------------------------ REVIEWED -------------- --------------------------------------- DATE------------------------------------------------�-........ BUILDING PERMIT ISSUED--------------------------------------------------------------- r Alterations and/or recommendations:--T-A. �f+ ._ / j am- � 1 � W ✓` Gee s 3 a�!"li'f 1.� ./ /.. -------------- ----------------- --------------------------- - -- ------------------------------------------------- FINAL INSPECTION BY:--- ... .... .. .................. Date-.-----I- --- --- ------ ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 5 camore Street 814 North "C" Street 130 South American Street 300 West Oak Street y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100