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INP , , r APPLICATION FOR SANITATION PERMIT Permit No. !f"` (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 This application is made in compliance with County rdinance No. 549. work herein described. JOB ADDRESS AN =OATION.... Owner's Name--------- _ c - •-------------=Address_ �-- Phone-P d-- ---- -- 7 -_ ----_----------------- --------•-------------------- -------- ------------ Contractor's Name___________ ----------------------•--:�, _ ____ Phone_ Installation will serve: Residence Apartment House ❑ Commercials�7 Number of living unitsk�'n El Trailer court ❑ Motel E] Other �— Number of bedroom Number of baths I-_----- Lo Water Supply: Public system Lot size Y ❑ Community system --------------- Character of soil to a depth of 3 feet: Sand ❑ Y Grav�(]Pr'Sandy Loavate m e[]pfh tClay Loamo Water E3 .CIe ft. Previous Application Made. Yes ❑ NoConstruct ❑ Y ❑ Adobe Hardpan ❑ (] New ion: Yes �No [J 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__&-De, ance from foundation___.- �__---- Material" ------------- ❑� ------------------ No. of compartments ______ �r tr p ��-----.----Size__a'_�c �_�--- Liquid depth-----oZ-.-_ ..'+ Disposal Field: Distance from nearest well--_.4__r_Distance(ofr�mr foundation___2U Capacity.__ Dr Number of lines--------I- --__- __._Disfance to nearest lot line- Number 1 �. -�---" Length of each line----tO_l�_'� Width of trench----- f� _�' Type of filter material-------- Depth of filter material--------- � .Total length--- --Q_!-- ---- Seepage Pit: Distance to nearest.well----------------------Distance from foundation__.___ El ._ ______".______-_ Number of pits------------------ Cesspool: Distance from -Lining material------""""-- . _.Distance to nearest lot line_ ----------Size: Diameter-----------------------Depth--------------------------------- nearest well___._______" _Distance from foundation.--.--__ ---!.-' Lining material--------------- ❑ Size: Diameter-------------------------------------- ----- - ------ Qepth - -- Liquid Capacity ----------------------------------- Privy: Distance from nearest weN----------------------_--__ Dgals. istance from nearest building___"____.._•.__ ❑ Distance to nearest lot line_.-__--- --------------------------- --------------- ________ Remodeling and/or repairing (describe):------ . - ` + -- -' ----------------------------------------------- -----------------------X------------------------- --------------------- ----------------------------------- ----------------------------------------•-----------------------•-------------•----------------------------------------•------------------------ ---------- ----------- ---- --- - - I hereby certify that ave prepared this application and that the work will be done in accordance with ordinances, State laws, a rules and regulations of the San Joaquin Local Health District. San Joaquin County (Signed)-------- -------- - -------------------- gY= - - Contractor) ,.,r.o. 3..r i _ C or) ----- (Tale)----> {Plat plan, showing size of lot, location of system in r anon to wells, tuildings, etc:,"can be pla -- ------------------ ced on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY DATE --------- .7 ------------------------------------------------ -------------------------------------------------------------- BUILDING PERMIT ISSUED------------- DATE. �` ------------------- :: A terations and/or recommendations---------------- ATE------------------- �/ _ ------------ 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 ES-9-2m ; IRevised W-2100