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APPLICATION FOR SANITATION PERMIT Permit No. .....l_ (Complete in Duplicate) Date Issued _.-/ - ---- Applica{ion 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 49. JOB ADDRESS AND PSATION.______._!C1__ tJi 0---_----------, L. ----- -------------------- ---------- --- -------- - -- Owner's Name -7 --------- Address ------ j(��/� - Phone _ _� U_.`.f Address----------- -------- --------- ------------------------------------------------------ ----0. ...... ontractor's Name----------------------•------------ -- �YI`9/._S /1.�---------- ----------------- Phone_ d ----- ------------ Installation will serve: Residence i( Apartment House [I Com mercial El Trailer Court E] Motel El Other E1_' Number of living units: __-/___ Number of bedrooms r'- Number of baths I... Lot size ------ -X4--/9-T-•-"�'-�-�-�'�-------------- Water Supply: Public system ❑ 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,-JZ�__New Construction: Yes ❑ No ❑ , TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permuted if public sewer is available within 200 feet.) e •c Tank: Distance from nearest well________________Distance from foundation-------------------- L 1 /No. of compartments-------------- -----------Size---------•--------- -------.._Liquid depth-------------- -------.-Capacity-------- D' sal Fi d` ` Distance from nearest well- � �__._Distance from found ____.Distance to nearest lot line___-� Number of fines___________ --fit_ ___ __-.Length of each lin _s �Q__.- ---------Width of tre -_ _-__--_-- Type or filter material_ -�- - �,�--Depth of filter material ___f Total lengt Q!------------ --------- Seepage'Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of Pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__----_ ❑ Size: Diameter-------------------------------- ----Depth ---------------•-----------------------------------Li Liquid Capacity., f q --------------------------gals. Privy: Distance from nearest well - y_,------------------------------------------Distance from nearest building 9 ----- --- ------ ❑ Distance to nearest lot lima.._--__� _-_._- - � --- --•---------------•- Remodeling and/or repairing (describe)______________________________________________________ __ ----•-----------------------------------------•--•---- \ ati nan-'-------•--------------------•--•------------------------------------------•-------•------------------ I hereby certif that I have prepared this ap lication an that the work will be done in accordance with San Joaquin County ordin S}ate laws, nd rules d reguI ti s f the San oaquin Local Health District. � f (Signed)-- --- BY: ... f onfractos - - , ---- -----(Title (Plot plan, showing size of lot, location of system in relation t ells, buil ings, etc., can be aced on reverse side). FOR DEPARTMENT U E ONLY ------------------ APPLICATION ACCEPTED BY----------------------------------- _ ------ DATE- . REVIEWED BY------------------------------------- ---- 5 ------------------------------------------------------------------------------- DATE------------•-------------------------�------------- BUILDING 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 Revised W-2100