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APPLICATION FOR SANITATION PERMIT Permit No. ---4...09.--X (Complete in Duplicate) Date Issued Application 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 Ordinance No. 549. JOB ADDRESS AN LOCATION--- ---------------------------�-- -- ---�'-�---------- -- " a ----------------------------------------- Owners Name-- tt � ..� = - _ Phone ,� =1 Address. j! ------- ��------------------ --------------------------------------------------------------- -----------------/---------------------------- Contractor's Name-------- `�,� �- -- � C----------------------------- ----------------------------------------------- Phone 7 6-G •2 �flrt" .'- Installation will serve: Residence Iy Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _o- Number of bedrooms ._2- Number of baths --0`: Lot size ---/Qd.`-_.-_--V 35e__________________ Water Supply: Public system Z Community system ❑ Private ❑ Depth to Water Table,(/_& ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe $ Hardpan ❑ Previous Application Made: Yes ❑ No 7 New Construction: Yes ❑ No 1% TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------..----. � .'4 No. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity------------------ isposal Rield- Distance from nearest well..-.--------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of lines___________________________________Length of each line----------.-.-----------------Width of french------------------._-__.-___-..-..- Type of filter material.._._-__f__________________Depth of filter material-----------------------Total length---.----------------------------------.-` Seepage Pit: Distance to nearest wellf}"_�_j�41/-----Distance from foundation--..- -0........Distance to nearest lot line___'Vd------- a` TKNumber of pits_-___1__________Lining material--4!�' ------Size: Diameter....---_3`_"-_.---_Dept h__-___ _"---------------- N Cesspool: Distance from nearest well----------------- from foundation___________________Lining material-______----.___-____--.--__-_.-___-- ❑ Size: Diameter--------------------------------------Depth-------------------------- ----------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------.--------------------------------------Distance from nearest building---------------------------------.----- -. ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------- -------------------------------------------------------- �b ---------------------------------------------------------------------------------------•----------------------.------...----------------------------.------------------------------------------------------------------ -----------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed) ./ ------=-- ----- wrier and/or Contractor) (Signed) (Plot plan, showing size of lot, location if' system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - ---- . "z` � `= "'ir ------------------------------- DATE----- /(f--.S-- ----- ------------------- REVIEWEDBY---------------------------------------------- ------------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------- ------------------------------------------------------------------------------------------- ------------------------------------ -----------------------------------------------------------------------_---------------------------------------------------------------------------------------------------------------------------------------------------- --------------------- ---------------------------. ------------------ -------------------------- --------------....----------------------------------------------------------------- ------------------------------ ---...I—------------------- -----------------------------------------•----------•------------------------- ---------------------------- ---------------------------------------------._...------------------- ------ ------------------------ --------------------------------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------ 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 I0-52 Revised W-2100