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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No- ---I- ------------------ { p p I -- Date Issued Com u �- [ ., Application 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. �� J JOB ADDRESS AND LOCATION--------- ff .. e 1 .- Owner's Name 35 GG :/ --------------------------------- Phone 9-_41r_ 7ZI-------- oev Address---------------•------------------ aPlf-- - -..-e�l. = Contractor's Name-------------------------------- ----------------------------- ---------------------------------- Phone----f-__�.F - 67 Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- Number of bedrooms 1 _. Number of baths _ ----- Lot size _ _ "- •�_Q_------------------ Water __--____ ____Water Supply: Public system 'Community system ❑ Private ❑ Depth to Water Table 441 ft. _t__ Character of soil to a depth of 3 feet: Sand L] Gravel L] Sandy Loam E] Clay Loam El Clay El Adobes, Hardpan ❑ Previous Application Made: Yes ❑ No !— New Construction: Yes No ❑ CZ TYPE OF INSTALLATION AND SPECIFICATIONS: O 1, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,I. tic Ta k• Distance from nearest well Distance from foundation_l0_--------Material_".-- �-�3'Lc No. of torr artments" } p '' - Size?--f___ ->5,---Liquid depth=-s�'�"xc`�---- ----Capacity----- Number oiowl om nearest well--l"�0 _.DistancArom foundation---/'9__ -_.-.-Distance to nearest lot line---�------ sal .F' �Dlstance fr''linas_-_--_"_�".-.. _ �+ r ri Length of each line__ a"."---___._------Width of trench------�L"-S'�-".------____"_____ I Type of filfer material_-�' _ p _,__Depth of filter material--- length r g a�---- --•- p g nearest well._-lY-___.___- Distance ffr n foundation--- -- Distance to nearest ne__447-"- See a Pit. Distance to Number of;pits----t --------------Lining material--"---- -"_V...--.Size: Diameter----,, I �-----Depth----- Distance from nearest,well-----------------Distance from foundation--------------------Lining material__-----------"-_--.------__--.---.--.- F 9 ---------Depth-----------------------------------' r ❑ Size: Diameter------- k'- Liquid Capacity gals. 1 Privy- Distance from nearest well-------------------------------------------------Distance from nearest building"--.-__"__-_""----------------- ❑ Distance to'nearest loti line------------- - ` -------------------------- li f � Remodeling and/or repairing (describe:---- --------------------------------------------------------------------------------------•------ •--------- --------------------------------------------------------------------------------------------------------------------------•---------------------------------------- -----------------•----•"-----------------•--------------------•------------------------•----•----------...--------•-------------------------------------------------------------------- ------------------------------------------------- -----------------------------•---------------------•--------------------------------------------------------------------------------I--------------------------- -- - I herebif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, tate a , and rulesjjnd regulations of the San Joaquin Local Health District. �r 4 (Signed) - ------ -- - ---- -- -- --------------------------------------- BY:-------------•-------_-- ---------- r Contract -------------(Title) ' -----------_-- By: ------------ (Plot plan, showing size of lot, location of system in r tion to wells, bui Ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._.-.___--__-.-__.-__"-- -- DATE------------ ---F-- ------------------------------------- ----------- - - ------------- REVIEWED BY ---- - ------------- ----------- DATE �"1� BUILDING -------------- PERMIT ISSUED------==------••------------------------------------------•-•---------- •----------------------- DATE----------------------------- Alterations and/or recommendations:------------------------------ -------------- ------•----------------- - ------------------------------ 1' ------------------•------------------- ----------------------------------------------------------•-------------------•--------------------------------------------------------------...-----••---•-----•---•- ------------------------------------------------ --------------------------•---------------------------------------------------------------- – --------------------------•----------- ------ -------------------------------------------------------- ------------------------------------------------- -------- ---•-------------------•--------- - ----------------------------- ------------ -- -----. ------------------- ------•------- ------------------------ FINAL INSPECTION BY:-------h Date 2-- ---------------------- ji 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 1 ES-9-2M 10-52 Revised W-2100