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I ' - APPLICATION FOR SANITATION PERMIT Perm" o. (Complete in Duplicate) y Date Issued _?1447--- 4;1 ___ -_47— - 1- p- cation is hereby made to the San Joaquin Local Health Dist rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54 . JOB ADDRESS AND LOC TION------- -- -------- ----------�- -------- -------- -- ---------------- ---------------------------- ------------•-------- �,Owner's Name Phone_ Addresst3. ------ ----- Contractor s Name----,----- � c Phone----- Installation hone Installation will serve: Residence Apartment House E] Commercial E] Trailer Court [3Motel L] Other ❑ ,a Number of living units: __/-__ Number of bedrooms-2-. Number of baths /___ Lot size __ _ __ .��~�� _____________-._____ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table waft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El-' 7 Previous Application Made: Yes 10 No ❑ New Construction: Ye sf No ❑ I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well________________Distance from foundation--------------------Material------------------------------------------------- ' No. of compartments--------------------------Size----------------------------_---Liquid depth---------------- --------Capacity---------- ------ I i Dispo I Fi Distance from nearest well.----------------Distance from foundation--------------------Distance to nearest lot line_________________ Number of lines--------------- -------------------Length of each line-------------------- _------Width of trench----------------------------------- Type of filter material_________________________Depth of filter material--------- _Total length_-_-______________________________________ 'r s Se epa e Pit: D"stance to nearest welL�_--__Distance from undation Distance to nearest lot line_._________ q , 'v Linin materia-----Size: Dia --------Depth---- -- -- (� Number of pits g Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------.---------------------------- " 1 ❑ Size: Diameter--------------------------- ----- ----Depth----------------------------------------------------Liquid Capacity----------------------------gals. I Priv Distance from nearest well_________________________________________________Distance from nearest building----g------------------------------------------ , ❑ Distance to nearest lot line------------------------------------------------•--- ---------• ---.._ -------------- -]--� Remodeling and/or repairing (describe):___ 7:;a �� -- - - - - - - j I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,DSfews, and ules and regulations of the San Joaquin Local Health District. (Signed) = (Owne an Contractor _ _ r or o 13t -------------------- ---------------------------------------- Title ,.= �''f-' r•----------------- --- --/!,�, f(Plot plan, showing size of Iation o system in relation to wells, buildings, etc., can be pla don reve se ssie. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- -- - ---- -- -------�2 �--------------------------------- DATE--------- -------- --- -- -- REVIEWED BY -------------- - -----------•------------------- ------•----•-----.-- DATE----- - --- ---------•-- S ------------ --------------- BUILDINGPERMIT ISSUED ------------------------------------------------------------------------- DATE----------------------------- ------------------------------- Alteratio d/ recommer�atj9ns- r+.-__._-". _ �,,JJ 1Vj ----- ---------- -------•--- ---- - -� ------ �- ----_ ------ -------------------- - ----- -- - - -- - R' ________________________________________________________-_________-_-__.______._._______.----__________--___-_______-.-----_--"-----_---__---_----___---_--__--__-________--__-__________---___________-_____--_------._--__ - FINAL INSPECTION BY:...�------------------------ -------------- Date------ s- �� f- --------------------------------- 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 f f ES-9-2M 0-52 Revised W-2100