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APPLICATION FOR SANITATION PER MIT P;rm it,�lo - 7 s (Complete in Duplicate) ` Date Issued Applica-ion is hereby 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 Ordinance No. 549. JOB ADDRESS AND OCA ION-------: -_1_-0�__ - - ------------ --- s Name wner' --------•------ -•--- •-------- -----•----- -------------------- --------- Phone a-+ 77 •-- ------------- _-- --- r -- - --------- Contractor's -----Contractor's Name ------------------ MP -- - ---=------------------------ --------- ---Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel J ❑ Other ❑ Number of livingunits: _. Number of bedrooms _ I �� / � - -� Number of baths ---�-. Lot size _�D _ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table --Yd ft. Character of soil to a depth of 3 feet: Sand ❑— Gravel ❑ Sandy Loam ❑ Clay Lo m ❑ Clay �,/ Previous Application Made: Yes No y ❑ Adobe r f-larclpan ❑ ❑ New Construction: Yes No [ TYPE OF INSTALLATION AND SPECIFICATIONS: c _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest weii-----------------Distance from foundation------------..-------Material ---_---_ - ❑ No, of compartments--------------------------Size ..Liquid depth--------------------------Capacity------ Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.__-----_- --___ ❑ Number of lines 46� -----------------------------------Length of each fine---------------__-- ---••---..Width of french----------------------------------- Type or filter material------ ------Depth of filter• material-----------------------Total length---------------------------------- ....... 5eep�e Pit: Distance to nearest Iwell__---- --�---___Distance f�om foundation_._- �.�_._-:Distance to nearest lot line_--sa2d Number of pits-------l-------------Lining material_�i____� _..Size: Diameter----. -- �e 5.� .--- Depth -cpjj Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material___--.__.-__-_- ------------ ____- El --- N ---- - - J Size: Diameter------ ------------------------------Depth--------- ------------ ---------- - ----- ---------Liquid Capacity----------------------_ • -_ gal- -"s-. Privy: Distance from nearest well---._.---__--_--.----_------------------------Distance from nearest buildin g -------------------- -- \.! El Distance to nearest lot line---------------------_--_.-_ Remodeling and/or repairing (describe)----------------------- --------------------- --------- G ---------------------------------------------------------------------------- ----••------------------------------------------------------------------------------------------------ ------------------------------------------------•-------------•---------•---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Slate laws and rules and regulati sof the San Joaquin Local Health District. (Signed) ----- ------------------- --- - --------- ----------- -------------------------------------------------------------- --- -- - ��rlrr and/or Contractor) By=--_--------- -- --------------- ------------- - ----- Title __ (Plot plan, showing size of lot, location of system in relation to wells buildings, etc., can be(rifle) on reverse side). -------------------------- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------------------------------------------ DATE. ED BY - - ------------ ----.- DATE--_ - BUILDING PERMIT ISSUED---------------------------------- -------------------------------------------------•---------------- DATE-. -------,tom----------------------------- Alterations and/or recommendations:------------ ------------ ------------- ----- ------------- --------- - ------------------------------------- - ---- - - -- ------- FINAL INSPECTION BY-------------- ------- --:��ee./,' P 3 — S-- ------------•• ---•------------- 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 ES-9-2M ; Revised W-2100 r