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i 61/' APPLICATION FOR-SANITATION PERMff it No. . (Complete in Duplicate). 4 Date Issued -------- , Applicati` is hereby made to the San Joaquin Local Health District fora permit to construct and inste8 the work herein de' This application is made in compliance with County Ordinance 549. JOB ADDRESS AND CATION , ---- ---_-------------- ••-- --- -- � . Owner's Name------- - ------------------------------------------------------ ----------------_--- Phone -_�`__. f Address------ -- ----- Contractor's Name-- ---•-• --- - ------------------------------------ -....................................................... Phone--- - Installation will serve: Residence Apartment House ❑ Commercial [j Trailer Court '❑ °J'Motel ❑ Other ❑ Number of living units: ___..- umber of bedrooms .Number of baths _--/__ Lot size __ Q_-4 ----------___------ Water ____Water Supply: Public system Community system F] Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa ❑ Clay ❑ Ado b Harm Previous Application Made: Yes ❑ NoNew Construction: Y El TYPE OF INSTALLATION AND SPECIFICATIONS: �- " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .; Septic Tank: Distance from nearest well_�D Distance from foundation---A�_ ----Materi _ No. of compartments-_c— ______-____Size__, ., y Liquid depth_, -4- ________Capaci#y_____ ' Disposal Field: Distance from iniarest well_________________Distance from foundation........_-----------Distance to nearest lot line___:., ..... Number of lines----------------------------------Length of each line------------.-----------------Width of trench. _.._-:-- :-------,• ._ Type'of filter material___ __ --Depth of filter materia) -------- Total length______ _________ __.......... �g .Pit: Distance to nearest well : .....Distanc4Tfr m' fou etion._:,1 __:Distance to nearest lot Y Number of pits__ ____ ___ Lining material Size Diameter- •, _�-.'___...Q,ptb r Q esspo L• Distance from nearest well Distance from foundation Lining w4utial. ............................ x Q Size: Diameter--- -•------ ----•.............Depth---------------------- - --------- -------Liquid Capacity ._.,.. _ c�. i?kvyt Distance from nearest well __ Distance from nearest building Distance to nearest lot line-------------------------------------------------------------------_----------- Remodeling and/or repaiiing (describe):----. --- �� ------------------------------------------------------------------------------------------- ----- --------------------•------------------------------••- •------- - - --._..-_ -•-----. _._ 1 -- 7--------------------------- n�------ ------- ------- -------- _--•-- ---- ---•--- ------- -------- ------- ------ --•- - ------ -------- - I hereby certify that I have preWod this application and that the work will be'done in accordance with San Joaquin envIliaences, State I , and d regia#ions of the San Joaquin Local Health District. ----- ----- - - - Y �-------------- ------•- -------------- -- - ---- --- - ----------- ,.................. _-Owner and/or C fral +oat �F. _ By:---- h ---------•• ---------------------------------------------------------------------(rifle)---�� ---- ------ . (Plot plan, showing a of lot, location of system in relation to wells, buildings, etc., can be placed on rse side).�� reve FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYE - DATE. --------- --------------------- REVIEWED -- ---- -- m REVIEWED BY--------------------------- -- ------------- DATE „� BUILDING PERMIT ISSUED___ - -- -- ----- ---- DATE ------------------ Alterations and/or recommendations: - --- - -- - -- ---- -------- --- --- ------- •------ -- --- --------------- ------- -------------- ------ ----------------- ---- --------------------- - •----------------- -- - FINAL INSPECTION BY:--------------------- - ------ ------ - --- Date t-r - -- .. - SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300<We`st-Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 [ '