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h �/, APPLICATION FOR SANITATION PERMIT Permit No. S'/,f . --•--•-•---.. ... (Complete in Duplicate) Date Issued`s/-7 ,y�'!jt 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 No. 549. JOB ADDRESS AN LO ATION._,,-'/ ,� ----------------- Owner's Name----- --�-- --------------------------------------------•--------------- ------------ Address•---------•-- ,� -------------------------------- Phone ............................. Contractor's Name--------- _ -- _ I_ - �L-_ ------------------------•--=--------------------------------------------------- f --------------------------- _-- �1�1 t? ---- --�i4/ �// Installation will serve: Residence 2 Apartment House ❑ Commercial Phone_1 Other 0 ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---_ Number of bedrooms _,l--- Number of baths _-_--_ Lot size ____--SD_-x Water Supply: Public system � ��--------------- Y (Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Cla ft. Previous Application Made: Yes Y ❑ Adobe Hardpan ❑ ❑ No [T� New Construction: Yes U�IVo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti Tank: Distance from nearest well-----------------Distance from foundation__-_._ No. of compartments ---Size------ -----Liquid depth---Materia----------Capacity Disposal ield: Distance from nearest we11: 2{ Distance from foundation.,.l0_' pistance to nearest lot line... -_---_• 2' Number of lines___ .l_-. ----------__Length of each line-_-_-_lo_o or' filter materia---/--- a_-- _--_- Width of trench-.-..2y- ___--_----------- Type Depth of filter material_--/$-"_-_______Total length___-__.Q�- .*--- ____ Seepage Pit: Distance to nearest well _____ - - ateriace from foundation _______________.Distance to nearest lot line_--__-_-__.___-__ ❑ Number of pits------ -----_. Lining material__- ------Size: Diameter--------- Depth Cesspool: Distance from nearest well-----------------Distance from foundation ❑ Size: Diameter-- ----------------Lining material--------------------- - - , Depth - -------- ----- -Liquid Capacity gals. Privy: Distance from nearest well---------------__ ❑ Distance to nearest lot line-_, ---------------Distance from nearest building------------------------------------- __-__----•---•_-___ _ Remodeling and/or repairing (describe)--------- -------------....................................................................... _ _,_ ---- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)----- '•--•Qta. ---------------------- -------- By: ner and/or Contrec r) - ----- (Plot plan, showing size of lot, location system in relation to wells, buildin s, etc. can(Title) 9 be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_. ----- •-------------- DAT REVIEWED BY----------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------- -- -..DATE ATE__ , Alterations and/or recommendations: - DATE -_' --------------------- ------ - .FINAL INSPECTION BY----- --- ----------- c ,l - ---------�""` ---------- Date---s.7 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wet}Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street ES-9-2M Revised W-2100 Lodi, California Manteca, California Tracy, California � - ,j