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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) p �/ Date Issuecl/x_'A-/_�--��-T k Applica{ion 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 County Ordinan e No. 549. /M1 ,� JOB ADDRESS AND LOCATI;5O _. _ . 1� �� ±` Owner's Name-.-- = --------- ---------- - - Phone- _-ra6. Address-----------•------------ Contractor's Name----- ------------------------------------------------------------------- Phone Installation will serve. :Residence [g-�Apartment House ❑ Commercial ❑ Trailer Court❑ .Motel El Other El°Number of living units: _-/.--,_ umber of bedrooms _- Number of baths --/-'-. Lot size _- '?------�L__/-ov------------------------- Water Supply: -Public system 'Number of ❑ Private ❑ Depth to Water Table -A-10 ft. Character of soil to a depth of 3 feet: Sand Q Gravel ❑ Sandy Loam ❑ Clay Loam Ej Clay ❑ Adobe gA-- Hardpan ❑ t Previous Application Made: Yes ❑ No New Construction: Yes ❑ No \� TYPE OF INSTALLATION A- irND SP€CIFICATIONS: �1 (No septic tank or cesspool permitted if public ewer is available within 200 feet.) Septic T Distance from nearest well-_ - - __Distance from foundation-.- •� f No of com artments.. e f'. -- ---__,___Liquid dap#h-- � '�___--__ fCapaci 0 p �------------ Siz sem? ----------- Disposal Field: Distance from nearest well--------------- --D stance from oundation--------------------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_- _ P 5 - 4 ,_ �..� ---------------------- _ . . See a it:' T .Distance to ne'arest.welL _,Disfanc f r' ~ -� _ ' ' f undation__� �------ Distance to nearest lot line----- Dumber of ts--- ------------ P -----Lining material�m__---- .---Size: Diamefer.-, - �t . Depth--�--5 Cesspool: Distance fiom nearesfi well----------------'Distance from foundation--------------------Lining material-------------------------------------- Size: Diameter------ ---------------------- _Depth------------- lF ------ ----Liquid Capacity--=•------------------------gals, Privy:.' Distance from nearest well---_---___-_--- _ i ----------------- --------Distance from nearest building-------------- ❑ Distance to nearestlot line.------` ' .. ---'-----=-----------------------I ---------------------- -•- - �, � -----------------••--------------------------------------- ` Remodeling and/or repairing (describe):--------------------------------------------- ---------- - w - ---------•------------------------•-----••---------------------•------•------------ ? ... = ------------- 4 ; y _ -------------------------------------------------------------------- ----------------------------------- ------•-----• I __________________________________________________________ ------------=--------------------------------------------------------------------------------------------------------------------------------------------------------------I----_-----__,--------------------------------------------- I'hereb rtify that I-have prepared this application an�rthaf fhe work•.will be dope in accordance with San'Joaquin County ordinances, to a laws`and rules and:regulations of the San Joaquin Local Health District. (Si ned 9 ) --------------------------------------- ---- ------ ... .•. (Ti I �� Contract --- ---------------------.---- -- ------- -- - -- , r Or) t e ------------------ (Plot plan, showing size of lot, location of system in relation t wells,'buildings, a ., can be placed on reverse side). FOR DEPARTMENT U5E ONLY APPLICATION ACCEPTED BY---..---:--I'__- ~ __-_ -----_- �• DATE----- - REVIEWED BY -------------------------- ----------------------- - - - DATE.----------- - . BUILDING PERMIT-ISSUED------------- -----•------••----------•-------------- = --------------------- DATE. Alterations and/or recommendations::----------------- ---- - �' ---" ---------------------------------••-- ------------ ------------------------------------------------------------ -------------•-----------•--------- - -----------------------------------------:---------------•-- ------------------------ -------------------------------------- - -------------- FINAL-INSPECTION BY..�� --------------------=---------- Date-------- --1,3 (5 .— 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 ES-9-2M - Revised W-2100