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APPLICATION FOR SANITATION PIE:RMIf* Permit No. ----- (Complete in Duplicate) Date Issued ___._��0� 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 Ordinance No. 549. JOB ADDRESS AND LOCATION----_ Owner's Name.--------- r x �1 res -----_- ----------------------- ----------- Phone------- ----------------------------- - ------ --- --------------------- Contractor's Name______ II ---------•----------•------------•---------------•--•------ --------- ---------------- ------ --•--••---•--- - Installation will serve: Residence, Apartment House Number of livingunits: _ ______ Number of bedrooms❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , ---- Number of baths __2_ _ �p Water Supply: Public system - - Lot size ------- a-................... Y 0. Community system ❑ Private 0 Depth to Water Table _,..;Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy.Loam ❑ Clay Loam ❑ Clay 0 Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Q New Construction: Yes ❑ No 01 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: iso carom nearest well-----------------Distance from foundation____._____._ ❑ o. o com� {mems SIZE. — Material ............................ - --------------Liquid depth--------- capacity Disposal Field- ista rom nearest welt_______________ ___-------------------- ❑ _Distance from foundation_________________.-Distance to nearest lot tine_________________ s-----------------------------------Length of each line-------•--------•----- Type of fit r material------ ---- Width of trench-------------------- --------------Depth of filter material-----------------------Total length--------------_ Seepage Pit: Distance to nearest welL__,_/i b'12--D-istance from fo datio _ Number of pits t' ......Distance.to nearest lot line__-�_--_ -_____Lining material__ `.__--_---.moi e.:Sameter___ Cesspool: Distance fi-om nearest well____________- Depth___ DlSfianCE from foundation__.________________Lining material-_._--____________._________ ❑ Size: Diameter----- ------ -------------- -------Depth------------------ ------...LN -- ----- ------Liquid Capacity Privy: Distance from nearest well---------------------------- gals.o _____________Distance from nearest buildin ❑ DIStaRCE to nearest lot line--------------------------- g------------•--------------------------�-� 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, Stat ws, and rules and regulations of the San Joaquin Local Health District. (signed)----------•---��.._ ---------- ----- _ 9� By:----- Y (O ran r Contractor) (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can(bel placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYREVIEWED _____-_.____-----t_--__ DATE..------- ----------------------------------------------------- BUILDING PERMIT ISSUED-- ------ ----------------------------------- DATE -� ----- _ Alterations and/or recommendations:____________•--- ----- --- DATE. _ •---------------= - -------------•---- --------------------------------------I----------------------------- �._ ----- FINAL INSPECTION BY:------ l --------------------� — ) ' --------------------- ate----------7------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES--9-2M Revised W-2100