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APPLICATION FOR SANITATION PERMIT Permit No,. ......_._ (Complete in Duplicate) 7 Date Issued -__------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein des This application is made in compliance with County O nance No. 549. JOB ADDRESS LO TION----- +a --•--•--•--•-• --•-----------------------------------------••---------•-•--- Owner's Name--- - ---- -I ---- -------- --------- ti Address-------1._ -- -- Phone -- - - ---- - --I----------- ontractor's Name.... ...VV - ❑ ___ __________ Installation will serve: Residence 'Apartment House Commercial Phone................................... Number of living units: j---- ❑ T��iler Court ❑ Motel ❑ Other ❑ -- Number of bedrooms ._!___- Number of baths"-fi__`__._ Lot size ______ _ ___ Water Supply: Public system �� PP Y• ...............................Y ❑ CorrYu?tfiitV-`system.❑ Private Depth to`Wa#er Table _______ ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam Clay Loan ❑ Clay ❑ Adobe Hardan Previous Application Made: Yes E] No 2New Construction: Yes l-7 No k p E]TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ No septic tank or cesspool permitted if public sgwer is available within 200 feet.) E Septi ark: Distance from nearest well_. /�_ (!__Distan a fr fou tion__.Z,0. _.._____' No. of compartmehts _ ._--_ _Size. 'x, t )` ----- -----Liquid dei-th--•---�-.{�:-- Disp Field: Distance from nearest wei--- 71 _//,,,, / Capacity J-Q_--_Distance from foundationel _ Number of lines___._.__._ ._ Distance to nearest t li a---------------- '11y ............... - -- ------_ Length of each lineWidth of trench_____._. --- - Type of filter mater .� t�._- ---------------- __ ____ epth of filter material_ ___ Seepage Pit: Distance to nearest well -Total length_______________ ---- Distance from foundaTion -: ❑ Number of pits______________________Linin material----------------------- -=�¢�stance to nearest lot line____._.______ _. gSize. Diameter--- Depth------- •--------- Cesspool: Distance from nearest well-----_-----------Distance from foundation---------_ ______ - Lini ,material------------------------------------ Privy: -- - -- --- - -- Aance : Diameter------- - -- ----------- - �,; Depth ------- --- Liquid'°CapacitY- ------------------------gals. Privy: I from nearest well _______ ______ ❑ Distance to nearest lot line_ -------`------Distance from nearest 13uildin 9 Remodeling and/or repairing (describe): -__ tir- -- -----•- ... ----------------- ----------------------------------------- --------------------------------------------------------------------------•------------------------*-------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joa uin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, q (Signed)•----- '------!cJ.-�G-: ��--------------------------------------- ------------------------------------------------------ :, (Owner and/or Contractor) -- --- - -------------(Title) re_._. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on verse side). FOR DEPARTMENT MENT USE ONLY APPLICATION ACCEPTED BY --------------------------------- --- DATE----1- r BY-------------------------------- ------ ..--~,-------------------- - SATE BUILDING PERMIT ISSUED__________ _____________________ _ � - Alterations and/or recommendations:__-_-_--- - ---------------------------------------------------- DATE-------- t.................................... ----- FINAL INSPECTION BY:.--------- "/------ ---- ---------------- Date_-- ' --_----- / - S SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street L 814 North "C" Street Lodi, California ES-9-2M IO-52 Revised W-2100 Manteca, California Tracy, California