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APPLICATION FOR SANITATION PERMIT Permit No. -- --- ---S - (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for 9 permit to construct d install the work herein described This application is made in compliance with County Ordinance No. 549:# *�' V►¢ JOB ADDRESS A LOCATIO •••............. ----•---- �. -- -- ---- Owner's Name - .....TYLr •QPhone: ',: +_ Address--------------I--- - --- -- -------- ------- - ---........... . ._1.±d1 .. ; �.. _. .. ' ext 4 : Contractor's Name--- -----•--------- ------- -------••-----•---. --------- ------------------ ------------------------------------------ Phone.................................... Installation will serve: Residence (�Apartment House ❑ Commercial ❑ Trailer Court Q. M I ❑ Other ❑ Number of living units: ---L Number of bedrooms _24_ Number of baths __ ____ Lot size . _ ___ ___. _ '...:.........: Water Supply: Public system 04 Community system F1 Private ❑ Depth to Water Table ft_-- Character of soil to a depth of 3 feet: Sand 171 Gravel ❑ Sandy Loam ❑ 'CTay-L-abm ❑ Clay ❑ Adobe Gt 4ardpan Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)�} r Septic enk: Distance from nearest well ,Dis#anc (from undat'pn 1_D_._.-Mat rjal - - [✓ No. of compartments____________ _t--_______Size__. __k_ _ Liqu'rd deppth_._-_ _______..... Capacity___ (e� Dispos Field: Distance from nearest well__-=--___-___Distance from foundation�'�.�l�c�t.__._ istance to nearest lot IJ `'..... Number of lines.. __--44- 3__:__-__- Length of each line_c � Width`of trench_____.T e of filter materis �yp epth of filter material___.__ _ ____:_._Total length_.._--�. _____________�;..._. Seepage Pit: Distance to nearest well--_--____ _-___._--_Distance from foundation -_--,---.•--,___.Distance to nearest-lot line.....:..........: QNumber of pits---- -----_--------Lining material-----_ •-------------Size Diameter---_-------------------Depth-------_----- Cesspool: ,__-Cesspool• Distance from nearest well-_------------- from foundation------------.......Lining material..:................___77--- - ❑ Size: Diameter--------------------------------------Depth------------------ - -----•Liquid Capacity ---•---- .- ---.....gals. 1 Privy: Distance from nearest well----------------------- ______ ----------Distance from nearest building--------------------------------------X ❑ Distance to nearest lot line-----------------------------------------------------------------------------------------------------__:,.................................. RerrLade' and/or:' pairi (describe):.A - -------------- --- ------ ---- -- •.------. r.% ----- ------- ------ - --------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ed ---------(Owner and/or c#rir BY - ----� --- -- - ----------------------------- ---- ------- (Title) ------ � .' - `t (Plot plan, sho g size of lot, location of system in relation to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - ----- DATE_ REVIEWED BY BATE_ _ BUILDING PERMIT ISSUED--- ----- ------ DATE_'.............. - Alterations and/or recommendations:-------------------------------------------------------------- --------------------------- - ----- --------------------............. ----- ------•------- ------- - - ------ ----------------- -- - ---•- ----- . - -- ------------- - FINAL INSPECTION BY:--- -- f ` ---------- Date--------- =_ .. 1.JOAQUIN LOCAL HEALTH DISTRICT 130'South American Street 306 West 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 -