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APPLICATION FOR SANITATION PERMIT Permit No. 1;" "'" """ (Complete in Duplicate) U� f�� Date Issued /.7 - plic�eFi`an is hereby made;to the San Joa uin Loc 1 T ' application is made in compliance withQCountya0 Ordinaalth nce No.ist No.5 9. a permit to construct and install the work herein described. JOB ADDRESS AND L CA ION. --------------- •-------------- 3 Owner'sName-- - ' � /I... ress_____. _. ----- - ------ ------- --------------- ------- __ - Phone A -------- ----------•--------------------------••----------------- ------------------- Contractor's Name-----•-------••--••----- •- - ---------•------- - --- ❑ Phone- Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---�__ Number of bedrooms -4-9 Number of bafihsLot size. C> _-__:,,�_-_ _Q_ ______ Water Su I . Public System Communit s stem .. ---------" pp Y� Y Y ❑ Private ❑ Depth to Water Table�dit. _ ---I- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ I Previous Application.Made: Yes ❑ NoNew Construction: Yes ❑ No e TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well No. from foundation__.___-______."___.Meterial____._.__-_____.__.----------------- � No. of`compartments____---_---- ---------- Size----- --------------------------Liquid depth- --------- -- -----------Capacity----------------------- Disposal f=ield: Distance from nearest well-----------------Distance from foundation_________________ Distance to nearest lot line .` Fj{Q�L / .-Alum6er of lines---•-------------- ------- Length of each fine---------------- VY �'` -------------Width of trench-- -------------------- r Type of filter material-------------- ----------Depth of filter material----------------------- Seepage Pit: Distance to nearest well- Total length______________________ ------------- Number __ ____ ______" .�2�.r___Distance f - �ID � Number of pits____.." n on__�a-"-_- to nearest lot ___----- V ""-________Lining material Size Diameter_ rCess ool: ..Depth------- -- P Distance from nearest well-----------------Distance nation---_-------------- _""__"- "" ".Lining material______--"-_-_"-__ "" " ❑ Size: Diameter------ ---------------'-------- ------ Depth -.Liquid Capacity-------- els. Privy: Distance from nearest well-------_----------------------------------------- g Distance from nearest building------------------------❑ Distance to nearest lot line____________ _ Remodelingand/or repairing (describe)-------------""-" ! hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and r s d regulaf.ns of the San Joaquin Local Health District. (Signed)----------- n, ----- - - ------------------------- --------------------------------------- wne BY: 7 f (Title)---- -- M r 6e). ntractor) ----------- ------ --- ---- •---- --- (Plat plan, showingsiz lot, location system in relation to wells, buildings, etc., can be pl on reverse si FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - DATE - REVIEWED BY----- .� ----------- - --------' --- DATE---"� 1, , BUILDING PERMIT ISSUED- ----------------------------------------------------------------------------- DATE---------kS Alterations and/or recommendations:. ---- ------- ------ ---• -- ------------------------------ -- - -- --- -- ---------- ----- FINAL INSPECTION BY:__-"""------ "--� y ( ------- Date ------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 30D West Oak Street 132 Sycamore Street Stock+on,'California 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2ip0