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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) o Date Issued / - Applica{ion is hereby made to the San)Joaquin Local Health District for a permit aocon}u t and install the herein dribed. This application is made intcompliance with County Ordinance No. 549. . JOB ADDRESS A OCATION__ —- -- .I ` Owner's Name---- _1! fes--•------- c��<_J j� 1 ( #� --------------- Address------ :� "" Phone_.. ----- - - --------- ---- . -=-----1 V --------------------------•-------- ._ Confiractor's Name__._ ZZ - -•-----------------------------•--- Phone_ Installation Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer-,Court ❑ Motel ❑ Other ❑ r Number of living units: -J_ Number of bedrooms _ Number of baths ___1__ Lotsize .__t._v�'_ ""--, Water"Su I Public;s stem = -- PP Y' y Community"system ❑- Private ❑ Depth fo Wafe'`Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam.❑ Clay Loam Clay Y ❑ y ❑ Adobe[ Hardpan ❑ Previous'Application Mader Yes ❑ No,[Z New Construction.,Yes&' No.❑ TYPE OF INSTALLATION AND SPECIFICATIONS: T F. (No septic tank or cesspool,permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_!Vo� -•Distance from foundation__- .,�c Material � - .c '� ------------------ o. of compartments------, _. ��Si ---.." �--•-..Liquid depth'_.._&_A--------------Capacity_..__�,~!z�_ Disposal Field: Distance from nearest well /_.___"__Distance from ---------- to nearest lot link_-••f 6 t % Number,of lines----- - -------: Length of each line----__ - j g ----, Width of french. `� Type of filter material-__ 5kDepth . filter material__'_____,�,45_"`--_.Total length ` See a e Pit: D, -11 s .: . ... : L _ 9 ---------------------- p g tante to nearest well_-�IIOr _:_ u --Diatance�from fo ndation_-__ ..(} •._.__.Diafiance�to nearest lot line___._______ Number of pits"'_:..1-__-._'_____Lining material_i°_C c.� ize: Diameter ------Depth ...Z20--F s Cesspool: Distance from nearest well:___.'____'____:Distance from foundation._:._.__`..__ ____Lining material____-___..____.___ 1- ------------------ ❑ Size: Diame#er ---•----`------------3-----------Depth----- '---------------------------- Liquid Capacity - 9 P Y „, % ,. F -------------gals. Privy: Distance from nearest well_ __--------------------------- :__" Distance from nearest buildin ` ❑ "' Distance to nearest:lof'line--"- :w„ - ==-------=--- 4- ------------------ 9 - t Remodeling and/or repairing(describe)----------------------------"-----__--- ---------- --------- -------------•---•- ! " ---- ---•---------••--- -- -----•------ -- -- ----------------- ---• ----------------------------------------- i f ------ I •------ ----------------- I i ----------------------------•-----•- ------- _----------------.----------.----------- -------- l.hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-lays, and rules and regulations of the San Joaquin Local Health District. i �� (Signed)-•-----•-----r --•--------- ----- -� / - - _ . , (Ow er and/or Contractor) Plot Ian, s owin size of lot, location -------`------- --------"""-'Title)_-_ _____.._-__ " ByL --- ----- ----- --- ( p 9 system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMI=NT USE ONLY - APPLICATION ACCEPTED BY----------------- -- -- -------------- •------- _ DATE VIEWED BY-------=-- ----------- ----------- - _ - -- ------ -------------- ----------------- ----- -------------- DATE ._: BUILDING PERMIT ISSUED------------- : f _ --------------------------__ _______________ ----------- -------------------=---------------------------.:___ DATE-- Alterafions and/or,recommendations F ------------•---------•-------- ` _ ------- --------------------•-------•--- ---••----••- -------•---:-------- ---._---. -- . -- f •----------- ---- -----------r--------- ----------------- ----------------•---•---•-= --------•----••------------------ 11 r ------ ------------------------------------ ------------.------------------------ --------------- FINAL--INSPECTION BY:.._ _ , - _ ------ 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 E$-9-2M Revised W-2100