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APPLICATION FOR SANITATION PERMIT Permit No. _ y" (Complete in Duplicate) /a ,5' Date Issued ___..�__._ _ Application is reby 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 Ordina/ncel No. 5-4f9. JOB ADDRESS AND LOCATION-------�.io...... Owner's Name------------------------------------------- '4''��- -------- . ----------------------------------- Phone----------—................ Address--------------------------------------------- y�iz Contractor's Name------------------------------------ - -------------------------------------------_--- Phone--------------------_--•--------- Installation will serve: ResidenceX Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __z--Number of bedrooms _z___ Number of baths __ __ Lot size -------f3.' �___�.2-_�________________________ Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table .Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam F] Clay Loam ❑ Clay ❑ Adobe„M Hardpan ❑ Previous Application Made: Yes ❑ No tt New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ti` Talk: Distance from nearest well_________________Distance from foundation------------------..Material--------------------------------------.--___-__.. ,E?.�, �►� `,}-^.No. of compartments-------------------- -----Size---------•-----------------•----Liquid depth--------------------------Capacity--•------------------� Disposal Field: �j Distance from nearest well. -0---- Distance Distance from foundation_IP_�_____._.Distance to nearest lot line__�_.�___- Number of lines_____ ________ _ _ ------------Length of each line....... -----------Width of trench._R.'�'.e.. Type of filter material__l � -------Depth of filter material------1_S.''.____Total length_-___-VQ_"_____ ______________ Seepage Pit: Distance to nearest well__/_D_Q'.---------Distance from foundation___1.C?............Distance to nearest lot line----- A_-_'__ Number of its.--- -----Linin material--_-----Size: Diameter_-J-3 .--- -'---------------- P g Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 1-71 Size: Diameter-------------------------------------Depth----------------•------------ ---------------------Liquid Capacity_----------------- ------gals. Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building_-__._.___._-_-______-__-_____.--_.___---. ❑ Distance to nearest lot line---------------------- -------------- Remodeling and/or repairing (describe):-------------------------------------------------•---------------------- ---------------------------------------------_:--___----------- --------- ----------------•--------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------- I hereby certify hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la s, and rule and r gulations of the San Joaquin Local Health District. (Signed)- Gf 1 }111. Contractor) ?L> �� t C BY�----------------------------------------------- --------- ------------------------(Title)- ==� •1 zc .__ ...F.`.----- (Plot plan, showing size of lot, location of system in lation to wells, b dings, etc., can bela-ced on reverse side). P ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- ---- ------------------------------------------------------ DATE-------,/----� REVIEWEDBY------------------------------------------------------------------- ------ DATE-----/------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------------- Alterationsand/or recommendations--------------------- ------------------------------------------------------------------------------------------------------------------------------ ••--------------•------------------------------------------------------------------------ ---------------------------------------------------------------------------------•---------------•-------•--••-------•----- ------------------------------ --------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------- ------- -- -------------- --------- -- --- ----- --- ------- ------- -------------- ------------ -------- -------- ------- -------------- ------- -------------------- e t, FINAL INSPECTION BY:... ----------------------- Date fz/- 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 10-52 Revised W-2100