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p � 9 { 5 APPLICATION FOR SANITATION PERMIT Permit No. .... -_- -_0 t € (Complete in Duplicate) 3 w Date Issued �11ppiication is hereby made to the San Joaquin Local Health istrict for a permit to construct and install the work herein e In described. This application is made In compliance with County Ordina e No. 519, JOB ADDRESS AN ;LOCATION ------------- ---- --------------------- __0 - Name------ -1-4e.--•------------------------------------------------ Phone Address----------------r- f _ ----------------------•--•-•-------------------------------------•----------- ---••------ Contractor's Name----- ------------------ • --------••---•=-------------------------------- ---------•----------•---------------------- ------ Phone � F Installation will serve: Residence aApartment House E] Commercial f:] Trailer Court ❑ Motel ❑ Other�9 Number of living .units: ---L Number of bedrooms 2__ Number A -�#h3 - --_ Lot size --_ Q- _ _ ] ��. Water Supply: Public system ❑ Community system❑ rlvate Depth'to Water a-bis'" ft. Character of soil to a depth of 3 feet-' Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Mane: Yes ❑ No New Construction: YesNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' A 1 (No septic tanktor cesspool permitted if btc se er'is available within 200 feet.) 11 1 1 ' ; �7 Se tic ank: Distance from near,,St wel-- .�! - +/ I Istancf fro fou _ ion- -- - No.'of compartmeJs s---------- -"Siz' ---�- ------• -- Liquid depth----- Capacity-•-- !�' Dispa I Field: , Distance from neart w €l ©_�Istance from foundation istance to nearest lot ling-- ------. I a �./ _________ Number o� lines------ --- ---- --------- -Length of each line------------------_-__-- __---Width of french----- ype` or' filter mate _ ��'(�—B � f epth of filter material--------�_> __1___-_Total length----------- Pit: Distance to nearest well--------------.-- _-Distance from foundation----------- ------.Distance to nearest lot line El Number of pits----------------------Lining material-----. ---------_----Size: Diameter----------------------_.Depth--------------------------------- Cesspool: Distance from nearest well- s-.- DEstae tom foundation Linin material---------------------------- P - -------- . � ------- ❑ Si : Dlenieter - = Z;r---- ----------------------------------D.e,fh p ' - --Liquid Capacity... gals. Privy: Distance from nearest well------------- -.----1�-�-_ `-------------Distance from nearest building--------------------------------- El Distance to nearest of line------------------------------- --- e Remodeling and/or repairing {describe):------------------------------------------------------- I -------- •---------------------------------------------------------- ------------------------•--------------•------------•-------------------------•- ---------------------------- ----- -------------------------- --------------------------------------------------------- ----------•---------------------------------•----------- -----------------------------•------•------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I . ss and ru s and r lati sof he San Joaquin Local Health District. (Signed)_. -t -� - - - --------- - v v ---------------------(Owner and/or Contractor) By--------------------------- •------------------------1-----------------------------------------------------------•---------------------(Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ------------ --- --------------------------------------------------------------------------- DATI — BUILDING PERMIT ISSUED REVIEWED BY----------------------------------- ------ DATE ----------------------------------------------- --- - ---- - ----------------------------------- DATE----.-- - --------------------------------------------- Alterations and/or recommendations:-------------------------------------- - ------ ��- - -- --------------� _._.------- -------------------------------- - ---- -- - - ----- ---------------------------------------------•-•----------- --------------------------------- -----•---- --------------------------- --------------------------------- ---------------------------------------------------------------- ----------------------- ------------------------------------------------- FINAL INSPECTION BY:--- ------ Date_........ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton. California 1 Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100