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\ 6 �f . / APPLICATION FOR SANITATION PERMIT Permit No. ----- Y/ in Duplicate) G I (Complete p } 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. r This application is made in compliance with County Ordinance-No. 549.' JOB ADDRESS AND L TIO _ ----.. -----•- • - ---- -------------------------- Owner's ------------------------ Owners Name----------r --•- -- -- ------ - ---------------------------------------------- Phone-----•----------•-•-•-•-----------•- Address :..._. -------------- ------------------------------- Contractor's Name . . ,YY-- ---------------------------------------------•---------•--- Phone---�. Installation will serve: 'Residence 1�1_ Apartment House-E] Commercial ❑ Trailer Court [3Motel [jther E]! � �r pp Number of living units: __ .:.. Number of bedrooms _ - - Number of baths ---/__ Lot size (4�� -_.t�._. ..__..-.•_ ----------- Water Supply: Public{system 0.. Community system ❑ Private ❑ Depth 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 P.—New Construction: Yes 21_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank Tor cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest well.._X/lY1F_Distance from foundation-----/A---------Material-_)f ci_ No. of compartments-.----."?-------------Size_...1_._�7_X;:1� C........Liquid death_------�.D-----------Capacity-----.1/r-------- Disposal Field: Distance from nearest we1l--/1/d''tR_--Distance from foundation---16-----------Distance to nearest lot line__----._. /--� ' Number.of lines------E----- 7 ------------Length of each line--- ---------------1t---_---Width of trench-----�'� ------_---------_-- Type of filter material--- -..-;._ _Depth of filter Material:._--/-V---------Total length----------j'r ....................._-_ t � Seepage Pit: Distance to nearest well--- from found tion.............:.....pist`�e to nearest lot line�,1 Number of pits------J------------Lining material_C.C4-...-. 1,ie: Diameter-- ------ ---Depth---- ------------------- Cesspool: Distance from nearest well-----------------Distance from .foundation--------------------Lining material------------------------------------- ❑ Size: Diameter----------------------------------.--,De th-----------------' --------.------------------Li uid Capacity p . q - --------------------------gals. Privy:: Distance from nearest well--------------------------------------------------Distance from nearest building..:......--_-.-------------------------- ❑ 'Distance to nearest lot line-------- ------ .. --------- --- ----------------- ------ ---------------------------=-------------- ------ f a r- Remodeling Ind/or re ring (describe):_!-------------------------'-------= [ -------°--f----------------------=---------- t '�' K--- '*' �"'-,�--r -,,�+ .1.. .y`. •------------- ------------- ' - ' " + "'• E,#'{ . ! .-----------M�e.+--"'-`--------'�'�'�.'. L; ' { tv-._34 a V ------------------------------------ --- -------------------------------------------------------••----•---------------------- -------------------------------------------- ------------------------------------------------- I hereby4*a itTn t I have prepared this application and that the work will be-done in accordance with San Joaquin County ordinances, Sand rules sand regulations of the San Joaquin Local Health District. (Signed)--------- ---- - ; _ (O ner and/or Contractor) gY� = -a (Title) ----------------------------- ------ (Plot plan, -showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ - ---- ------ --- ----`-------------- ------------------------------------.... DATE------ ('-- -----------------•---------- - REVf EWED BY---------------------------------------- --- -- - ------ DATE------ --------f ---------------------------------- BUILDING PERMIT ISSUED F i ` ----- -- ± ....... - DATE Alterations and/or.recommendations-------------------------- ........____-_...._---------_-----__----- --------------------•--.•-------------------------------------------------------------------------------------------------:---•--------------------..._...-•----------------.....-..-------------------•------•--- -------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ ------------•---------------------------------------------------•------ ----------------------------------------------•----------------------------------------------- -BY ::-FINAL INSPECTION ....Date ZZ ----. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Streef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised W-2100