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y, APPLICATION FOR SANITATION PERMIT Permit No. __- -_ - _- ,� (Complete in Duplicate) Date Issued ___�,/5�__--- ApplFca-%n 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 Cou ty Ordinance No. 549. JOB � DDRESS AND L CATION__-_ :f___, -- - "1 -------zu ---------Q 1 ------ Owner's Name - fx.a. s .� 4- I ------ - Phone_. -_---___-•- _ Addr ss----------- 1 _ . --------------------•----------•-------------------------- ---------------- Contractor's Name___________________ - ------•----------- ---------------------- _ Phone.+ �,e'--�A�7_ Install tion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: "�___- Number of bedrooms _ - .�Number of baths . � Lot size /.-1_.S' r ____ Water Supply: Public system [;Community system [3 Private E] Depth to Water Table .� ft Q . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Cla Adobe ` Y ❑ Y ❑ Y ❑ �ardpan ❑ Previohs Application Made: Yes [❑ No New Construction: Yes ❑ No E] TYPE IOF INSTALLATION AND SPECIFICATIONS: P (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic:Ta k; Distance from nearest well-----------------Distance from foundation-------------------- Material Na. of compartments -------------------------------- ------------Size------------------- -----------Liquid depth--------------------------Capacity--- Disposlsl Field: Distance from nearest well._--------------Distance from foundation--------------------Distance to nearest lot line__.____--___..___ ❑� Number or lines--------------------"--------------Length of each line------- of trench__"----------"-----_---- w Type of filter material--------------- -----`-- -------------Depth of filter material-----------------------Totallength------------------------------------------ See. je _""____.----_"___--•_----"----••----•-•-.Seepage Pit: Distance to nearest well-��-------Distance from foundation__......Distance to nearest lot line----/ O Number of pits----/--------_-------Lining materia! 5ize: Diameter____ ___ ` _ ,- Cesspool: Distance from nearest we!€_____________".__Distance from foundation. ,"__.__-----Lining material------------------------------------- El Size: Diameter--------------------------------------Depth------------------ ------------ ---------- - -----Liquid Capacity - ----- Privy: Distance from nearest well-_________________"_______--__- _._..___-----Distance from nearest buildin 9 ❑ Distance to nearest lot line----------- Remodeling ________Remodeling and/or repairing (describe):--------------------- ------------------------------------ { ----------- -- -------------------------• - I hereby ce i that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat I ws, and rule and regu ations of the San Joaquin Local Health District. r (Signed)---------- �� -- ----- --- - `/...-" r Contractor) -------------- ---------------------- -- By:. (Title) Sl_ 11 _. . - (Plot plan, showing size of lot, location of system in relation to ells, buildings, tc., can be placed on reverse side). �. �I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B -"------ DATE --------• •------ - ------------- - -- ------ REVfE ED BY------------------------------ DAT-- $UfLDING PERMIT ISSUED.. ------------------------------------------ DATE Alterat,� and/or recommendations:_-------•----------------------- ----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ------------------------ 11 --•---------- ----------------------- ----•---------`------------•------•---------- ----•-- FINAL INSPECTION BY:.- Date `S I$ �. _ _ ----------------------------------------------- SAN _____________________________________________SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street h Stockton, California Lodi, California Manteca, California Tracy, California ES-9—`2M Revised W-2100 r