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APPLICATION FOR SANITATION PERMIT Permit Noj!6, _-r_ (Complete in Duplicate) J, IITI Date Issued Applica+ion is hereby made to the San Joaquin Local Health D'strict for a permit to construct and install the work herein described. This application is made in compliance with ounty OrdinNo1 JOB ADDRESS LOCATION____ � • • -Cl ---------- -----=------------------------------------------------- - - Owner's Name-__ ___.-__ .71 --------- Phone L!- v � ------------------------------------------------------------------------ Address-----;�. ___ </ !!)------- ---- ----------- ............................................. Contractor's Name..... -._- -_ Installation will serve: Residen a Apartment House E �Commercial ❑ Trail r Court �17�1 Other ❑Number of living units: Number of bedrooms _ 1_ Number baths _-- Lot size ____--__ ------- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam ❑ El Loam Clay Adobe Hardpan ❑ Previous Application Made: Yes El No [(New E]Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well-----------------Distance from foundation-------------------- Material------------------------------------------------� No. of compartments-------•-----------/-----Size--- ---------------------------Liquid d9pth ------ --------------Capacity • Disposal Fi Distance from nearest elt is ante from foundation_I _ _r_- istance to nearest lob li --- Type it lines--------- -______ Length of each line______________ Width of trench_ -„ Type of filter mater T ----------------- --- Lu ��d'epth of filter material----1- _ -------- length-------"_ --- Seepage Pit: Distance to nearest well__-44_---------Distance from, ou�dation___-,26._ Distance to nearest lot line-_t--?__A--- Number of pits__-_______ __--_----Lining material____(-e___--_rfn4 Size: Diameter-__-.__.�_�__`-'______-Depth---------- ,_ '__--:_------ Cesspool: Distance from nearest well-.------------ from foundation_________--___.Lining materia- _ q ------------------------ ------------------------------------- ------------ ----- ❑ Size: Diameter----------------- -------------------De th----------------------------- - - __.._ Depth ---------------Li Liquid Capacity----'=-==`� gals. Privy:, Distance from nearest well-__-____-___-__________-_ 3 ___-_-_____-_-._Distance from nearest building-______ f ` ' ____-_-__- Distance to nearest lot line � . .: ----------------------------------------------- " Remodeling and pr repairing (d crib * _________________________ _ ' _____________________________________________•__.__•-____.___--_--_----- 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 reg latio of the San J aquin Local Health District. (Signed) - , _ `�':: .-------------------------------------------------- ______________(Owner and/or Contractor) Bn, s - - _- -----------(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- REVIEWED BY-------------- ----- DATE-- - - ---------------------------------------------------------------------------------- DATE---- ------------------------------------------- BUILDING PERMIT ISSUED ---------------------------•----------------------------.-...----------- Alterations and/or recommendations: DATE.... FI N ------------------------------------------ ---- -- ------------------------- AL INSPECTION BY:.------ =X "' —rte', .. 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 Revised W-2100