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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _____�----- -- sc •on is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein debed. Applicata y This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION..------- -�• f ----- 412�E .................. --------------- �j Owner's Name----------------------------------------- 1��- - ►1.[�L ------04-eiC.DaAl---------------------------- Phone_ - _ ------- ------ (?--------------------------------------- &?'1v Phone- = Q r� Contractor's Name 1� �a 12'.f /_ --"9b`-- f M Installation will serve: Residence E] [jr Court ❑Apartment House Commercial Trailer ❑ // otel Other [:1Number of living units: ___�__ Number of bedrooms _/-- Number of baths __L___ Lot size -___ - Q- ----- - Water Supply: Public system ❑ Community system '❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Cn! (No septic tank or cesspool permitted if public sewer is available within 200 fee.) Septic Tank: Distance from nearest well__-8-/---_Distan e km foundation_ ---------Material_ ______________ No. of corn pa rtments__a-------------------Size ---- ------Liquid depth ----------Capacity-41A - o Distance from foundations --- Distance to nearest lot line______�?`�_^_____._ Disposal Field: Distance from nearest well__Lf Number of lines________ ___ .____._ ____Length of each line_ -- -'1, ___.Width of trench---- of filter material___ --! __ Depth of filter material-----/- Distance Total 7-57 See a e Pit: D;stance t o nearest well_ _y Distance from foundation--------------------Distance to nearest lot line----------------- Seepage ---------------- it p9 Depth--------------------------------- ----------- Number of pits----------------------Lining material-----------------------size: Diameter-_-----------_----- Cesspool: Distance from nearest well________________Distance from foundation ______.____-_______.Lining material__-______________________________.-. O ❑ 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 that ve prepared this applic. ion and that the work.will be done in accordance with San Joaquin County ordinances, State laws, a1d ru sand re ulations o he San Joa in Local ealth District. _\- V� ° ----------------------------)1-,,, d ----- tr �orl (Signed)•---- --- - on y - ----------------------------{Titffile) _ y -- -_ -- -` - - ------------- B : (Plot plan, sho 'ze of lot, location of sy tem in relation to wells, buildings, etc., can be p7onreverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY '�'-- ------ ---- ------- -------------- ------------- - ------------- ---------------- - ----- DAT J------ ------------------------------------------ REVIEWEDBY----------------------------------- ----�---------------------------------- ---------------------------------------- DATE-------- --------- BUILDING PERMIT ISSUED `-C DATE Alterations and/or recommendations------------------- --------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------- ------------- -------------------------- ----------------------------------- FINAL INSPECTION BY:----------- Date------------ -- ----- ------------------------- 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 E5-9-2M 8-51 Revised W-2100