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IV hN 'a .� � APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) _-T----,//� /- Date Issued .- _T Application is hereby made to the San Joaquin Local Health District for a perm:+ to construct and install the work herein described. This application is made in compliance with Count OOrdinance p 5 9. JOB ADDRESS AND LOCATION Lit 1�- ' j- Owner's Name---------------------------------•------ .t-d ------ f�_s ------- Phone '-7_'�__,�,?------ Add ress___________________ Contractor's Name ' �+� # >R $�---' `-_ate.ons------fJ .--- Phone7� lca Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of livingunits: ___ Number of bedrooms C 7pr e)<%_A`�___©~_-_---.•----------_ --- _ __ Number of baths ___ ____ Lot size _�- __- Water Supply: Public system )C Community system '❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes ❑ No% New Construction: Yes ❑ No ❑ ww4 Aut.— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ] 9ptic Tank: Distance from nearest well_________________Distance from foundation-------------------Material______________-____________-_____________-.___. No. of compartments--------------------------Size---•----------------------------Liquid depth--------------------------Capacity----------------------- D- osaI Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of line° -----------------------------------Length of each line------------------------------Width of trench----------------------------------- 1 Type of filter ma�erial________________________Depth of filter material-__.___________ ----Total length---------------------.------ (_�__------ See pa ePit: Distance to nearest well- -------Distant fr m fo ndation_-./.&_______-.Distance to nearest lot line)----_&I. Number of pits____--------------Lining maferiafi __-Size: Diameter.-A3 Cesspool: Distance from nearest well________________Distance from foundation--------------------Lining material____________ ----------7�------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity---------------------------gal Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ElDistance to nearest lot line-------------- ---------------- ------------------------------------------------------------------------------------------------------------- a , Remodeling and/or repairing (describe):---- - ---- �_A ----------------••--•-----------------------------•--------•------------------ ------•--•-•-•--------------------------------------------- ---------- -----•---------------------------------------------------------------.-----------•----------------------------------- ----------------------------------------------- ---------------------•-------------------•------------------ ---------------•----------------------------------------------------•------------------ ---------------- hereby certify that ve prepared this application athe work will be done in accordance with San Joaquin County ordinances, S to lays, d ules and regulati ns of the S Joaqu Local Health District. (Signed) s -�`�-�*1` 0n�'T -C'f--------- ( Contractor] (Title) - 1 �-a- Y• ---------- --- -- Ti+le wS- (Plot plan, showi size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ___._ ---_________ DAT ------------------------------------------------ --------------------------------------------------- REVIEWEDBY ------ – -- ----------------------------------------- ------------------------------- DATE----�3� BUILDING PERMIT ISSUED -- -- - ------------------------------------------------------------------------ DATE------------- Alterat;ons and/or recommendations----------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------•------------------------•--------------------------------------------------------------------------------------------------- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------__-------------------------------------------------------- ---------------------------------------------------------------•--------------- ------------------------- --------------------I---------------------------------------------------------------------------------------- FINAL INSPECTION BY:-------, -.,�a-------------------------------- Date-.-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California .ES-9-2M B-51 Revised W-2100