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.- E • • APPLICATION FOR SANITATION PERMIT Permit No.---7---7-- yf. � �j (Complete in Duplicate) VE k� 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 Or 6ce 'No 49� JOB ADDRESS AND LOCATION.,,, __ ----------- Owner's Name ti a) - ----- Phone ---- ------ -- --_ '�----- � � ' ' ------------------------------------------------------------------------------------------- ------- ---------------- Address---------- Contractor's Name �4 1'= ---------------- -------------------------------------------------- Installation will serve: Residence VApartment House ❑ Commercial ElTrailer Court E] Mote Other Number of living units: __.�___ umber of bedrooms _ f ' ` r h`t. Number of baths _______ Lot size .__4'_-/_-_____-_�__ ---------------------- Water Supply: Public"sgsfvm Community system ©- Private-❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Q Clay Loarrl ElClay ❑ Adobe 02,"Hardpan ElPrevious Application Made: Yes ElNo ©`j New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if, ub)ic sewer is available'within 200 feet Septic ank: Dis,fance from nearest welt°:�'�� '`� n��c r � Ista�c� fror�jjfou tion__ _ Mate -__ - p _Ll_, Slzg� __?t :^ Liquid c(eptb " Capacity--- e- i� Nd- of compartments____ ✓- Dis os Field: Dijtance from nearest w !I ,../ �_ JDistance to nearest lot line--_ N mbar of lines___________________ 1 Length of each line_________. - ,,� � � tf ------ � Tye of filter materiS$ F ' ;i, Is 9 nce from foundation_ - � , Width of trench_. ___ti-- --- --------------- Depth --- - ------ t Depth of filter material---------1_ ----_Total length___-__ .._�__,� _:__-•- __---- Seepage Pit: Disific�-ftr•nearest well ----------- istance'from foundation_- 1 _--......Distance to nearest lot line-------------- Cesspool: ____________ r ❑ Number of pits______________________Lining material----------------------Size: Diameter----------------------Depth--------------------------------- Distance Distance from nearest well-----------------Distance from f dation__-________________Lining material-----------------------------_------- Size: Diameter---- - ---- ----- ---------Depth-----.----- Liquid Capacity --------- ------------ gals. Privy: Distance from nearest well _________________-_-_-__-. ___'�• tante from nearest building Is Distance to nearest lot line -------------------- ---------------+-------------------------- Remodeling and/or repairing (describe)--------------------------- ---------------------------------------------- ----•---•--•------------------------•--•-----•---------•------------------------ --------------•--•--•--------------------------------------------•------------------------------------------------------ ------------- ---------------------- I hereby certify thALLlioye Prepared-#his.applica#ion and that the k will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_ -------- --------------------------------------------------------------- --------(Owne r 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 L11 ONLY APPLICATION ACCEPTED BY__ ___________ -------------------------------------------------------------------------------- DATE_--------------- - REVIEWED BY__ _ - ---------------------------------------------------------------- --- BUILDING PERMIT ISSUED_-__-._-__`r-.-_:'__-- DATE__ ------------------------- -------------•--•-------- -----`1------------------------ DATE----- A aerations and/or recommendations:-------------- d ------------------------------------------- -------------------------- _. - - -----•- - --- -- -- - -- --- ... - FINAL INSPECTION BY:..--------- _ hW- Date -- .. ------------------------- ----- --------------- SAN - -- - -------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