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APPLICATION FOR SANITATION PERMIT Permit No. in Duplicate) yJ y ,.� Date Issued ----�C --� A -------- gcation 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 Or finance No. 549. JOB ADDRESS AND LOCATION�.....yvGy'-P------ �' � _ �°` •i Owner's Name -�%_-, :,�- -- ••--- - -- _11.x, ---- ------------- - ---------------------------phone--------------------•-----------•- Address-----------------------------------------•-------- ---------- --- =' -- -- Contractor's Name--------- /f -------------------------------- •---------------------------------- --- ------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑. i Number of living units: -------- Number of bedrooms -Z,.-- Number of baths --e--- Lot size Wafer Supply: Public system Community system [-] Private F1Depth 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 1�1-< ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic Ta k: Distance from nearest well_- �! -Distance from No. of compartments---------', r---____--Size-- -,1 �----Liquid dep�h--------�_---.........Capacity---"-4�__---- Disposal Field: Distance from nearest well------------Distance from foundation---Z�_-_--. Distance to nearest lot line----l.-------- Number o-i lines--------- ------__ Length of each line/.5__ � - �id.Wldth of trench-.- - Type of filter material__ i *4-4^- Depth of filter material----_ -_------Total length--------,/0- -------_------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------_.--------Distance to nearest lot 1ine----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter---------------------- Depth---------------------------- -_-- Cesspool: Distance from nearest well-----------------Distance from foundation---------------.-_-.Lining material-----------------._____--------------. ❑ Size: Diameter------------------------------------- Depth----------------------------------- ----------------Liquid Capacity- - ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----___------------------------------__ ❑ Distance to nearest lot line------------------------------ Remodeling ----------- --------Remodeling and/or repairing (describe):----------------------------------------- ------------•---•------------------------------------------------------------------------------------- ------ ------------------•------- ----------------------••------• ---------------•-•-------------------------------------------------------------------------------------------•-------•------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regulations of the San Joaquin Local Health District. Si ned 3 ( 9 ` --- --------- - `-'"---------------------------------- ---------------------------------------------------• -----------(Owner and/or Contractor) -------- By:-----------------------------------------------------------------------------------------------------------------------------------(Title)------ -------------------------------- # (Plot plan, showing size.of_lot,.location of system in relation to wells, buildings, etc., can be placed on reverse side). i FQR�DE-PRT ENT US ONLY APPLICATION ACCEPTED BY--- 1 DATE /<-Ail;---------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE-------------� BUILDING PERMIT ISSUED------------------------------------------- ------------------•--------------------------------------- DATE - Alterations and/or recommendations:------------------------------------- ---- ---------- -•-•-------------------------•-------------------- ---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ ----------------------------------------------------- ----------------------------- ----------- -------------------------------------------------------------------------------- FZktINAL 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 10-52 Revised W-2100