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6,11-Z APPLICATION FOR —� SANITATION PERMIT Aermit Not-9---7......... (Complete in Duplicate) Date Issued __71x_911 Application is hereby y made to the San Joaquin Local Health District for a permit to construct and instal! the work herein described. This application is made in compliance with County Ordinance No. 549. J08 ADDRESS AND LOCATION-------------"��L_---- ------ f - ,,�7 Owner's Name---------------------- Phone --------- ----------- -------------------------------- Address---------------- { 3----o` f''' �^''r j ' -7-------------------------------------------------------- ---------------------------------------------- Contractor's Name--------=---� ----------------------------- .............----------- ---------- ----------------------- ------------------------•---------- --------- ---------- ---- ------------- - Phone I Installation will serve: Residence Apartment House E] �oCmercial El Trailer Court ❑ Motel ❑ Other [) Number of living units: -- Number of bedrooms --/-- um r of baths _/___ Lot size _______ST_ 5 I1�' -------------------------------------- Wateh Supply: Public system 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 [j No New Construction: Yes ❑" No� TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V1 Sep is Tank: Distance from nearest well________________'Distance from foundation_____ -10-------Material------ ----- ------•- ---------- No. of compartments_____.-__—---------Size_____----�x` uid de th-___---- may--_ Ca acit q p _ Y 7----- 1 Disp I Field: Distance from nearest well---_----- ------Distance from foundation_--__P�----Distance to nearest lot line----�______ Number of lines_______________ _ -- ___ Length of each line----------/_ -v--------Width of french--------- f� Type of filter material------------- -- -----Depth of filter material---------14 ------Total length-----------------/XQ�'----------- Seepage Pit. Distance to nearest well________________ ______Distance from foundation--------------------Distance to nearest lot line_________-_______ , ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth--------------------- ' ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-____.________________ El Size: Diameter--------------------------------------Depth---------------------------•--------------- ------Liquid Capacity: gals. Privy: Distance from nearest well------------------------------------------------- from nearest buildin 9 ------------ ❑ Distance to nearest lot line ----------------- Remodeling and/or repairing (describe):-------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------.•--------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a l d ull and regulations of the San Joaquin Local Health District. /� Signed)---- ---------- ---- ----•--------- -- ---- 4 ------------------------------------------------------- ----------------(Owner and/or Contractor) By:----------- 1 (Title)----- --- ---- ------ ---- ------- (Plot plan, showing size of lot, location of system in relation to'wells, buildings, etc., can be placed on reverse side). j • FOR DEPARTMENT USE ONLY { APPLICATION ACCEPTED BY---------- ) =-------------------- -------------------o--------------------- DATE------------: ._ -�_lR —--------------- ........... BY ---- ------ --- --- ---'- DATE-_:---------- ------------------------------------------ BUILDING �PERMIT ISSUED--------------------------------------- --------------- DATE --- Alterations and/or recommendations:________Q- ,__ � . ---------------------------------------------- ----- ------------------------------------------------- ---------------- --------------------------------- ----------- FINAL INSPECTION BY:------- _ ------ ----------------- ------- Date------------� --- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Sfockton, California Lodi, California Manteca, California Tracy, California ES—' 9-2M 8-51 Revised W-2ioo