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k APPLICATION FOR SANITATION PERMIT Permit No. �__ _ (Complete in Duplicate) Date IssuesV!/S'3 Application 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 Or 'nance o. 549. 10� F JOB ADDRESS AND LOCATION /tc - ---- @:__-- Address Phone `_ .+ - Owner's Name ------------ ------------------------------------ �•xxy ----------------- -- - - - --------------- Contractor's Name . Phone---- __.__ .. 14. Installation will serve: Residence W, Apartment House ❑ Commercial ❑ Trailer Court El Motel E] Other ❑ Number of living units: --/_._ Number of bedrooms -I-"- Number of baths .1_-_ Lot size _-____ .6 ` ! �__ -d------------------ Water Supply: Public system 56 Community system ❑ Private ❑ Depth to Water Table 0�__-_�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)a Hardpan ❑ Previous Application Made: Yes ❑ No 0 New Construction: Yes ❑ No ❑ J _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ' Tan Distance from nearest well-----------------Distance from foundation__________---------Mater'sal � No. of compartments Size_ Liquid depth Capacity sal, iel�l: Distance from nearest well_._._______._.-_Distance from foundation___________________Distance to nearest lot line----------------- 11�` Number o{ lines----------------------------------Length of each line-------------- -------------..Width of trench---------- ------- Type of filter material-------------------------Depth of filte vial-----------------------Total length------------------------------------------ Seepaiae Pit: Distance to nearest well--KiDtf-1c-----Dista frog fo n ion___ _ Distance to nearest lot line------ld__7 Number of pits---T--------------Lining mate al_ .. ze: Diameter---s -J-- Depth---�- i --------------- Cesspool: Distance from nearest well-----------------Dis ce fra fo nclation------------------_.Lining material_______.._-_--___________.__-- El Size: Diameter------------------------------- -------Depth---------------------- ----Liquid Capacity- --------------------------gals. Privy: Distance from nearest well---_____________-------------------_`_-----------Distance from nearest building ------------------------- ❑ Distance to nearest lot line--------- -----------------------------*- ---------- { Remodeling and/or repairing (describe)____________________ ------------------------------------------------------------------------------------- --------------------------------------------------- ----------- ----------------------- ------------------------------------------------------------------------•--------------------•---------------------------------------------------------------------------- -------------- I hereb that I have prepared this application and that the work will b done in accordance with San Joaquin County ordinanc , if tate aw , and rules and re ulations of the San Joaquin Local Healf District. (Signed) lc�---------------- Contractor) By: �Qf.LJ (Tit] r-- --- -- - (Plot plan, showing size of lot, location of system in relation wells, buildings, tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------.------------------------------------------___ _-__ ��-- DATE / -- -3- -------------------REVIEWED BY ------------------ DATE - - ( - ----- --------------------- BUILDIN PERMIT ISSUED----------------------------------------- ------------------- DATE Alterations and/or recommendations------------------------------------------------------------------------ ------------------- ------------ ------- --------------------------------------------- ----------------------------------------------------------------------------------- FINAL INSPECTION BY:-----____________'_--'-_j` ---------- Date--------- ' 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 10-52 Revised W-2100