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PPLICATION FOR SANITATION PERMIT Permit No. �. z. i---? v (Complete in Duplicate) (0� l ,/� Date Issued 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 Ordinance No. 49. JOB ADDRESS AND LOCATION.__--- �/� r ----- ---------� } -------- -- •--- Owners Name----. ---------- ---------------------------- -------- ---- - Phone---------------------- ---• -�,�C,,.rte-----------`�-•------------ ------- Contractor's Name... ! -------•---•--•--------------------- ---------- ------------------------ --- . Installation will serve: Residence . Apartment House ❑ Commercial Phone--------------._ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I----- Number of bedrooms _-� Number of baths __ __. Lot size ___- - ---��__._/ Water Supply: Public system l-Q-�------- _---- Y ❑ Community system ❑ Private 2� Depth to Water Table {t, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Previous Application Made: Yes No �' X No Y Clay ❑ Adobe[ r Narpan ❑ ❑ New Construction: Yes ❑ 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 foundations !� No. of compartments Y_ Material ----------- --- ------------Size�7__ --`�.........Liquid depth. y � -- - �---- ------- CapautY--�O�J_- Disposal Field: Distance from nearest welf--�DP r Distance from foundation____-21C` to nearest lot line Number of lines------ -- --- - �-------------- of french-.4_ ---------------------- Seepage r - Type of filter material._ ----Depth of filter material___.- '�...... --------- W Seepage Pit: Disfiance to nearest we -- _ r Total length____.-c a_ ................... --___Distance fr m foundation___ � Number of its.... Distance to nearest lot line_- F p _ ming material_�----Size: Diameter Depth---s�_Z------- p Distance from nearest well_________________Distance from foundation----------.--__ ❑ Size: Diameter---------------------- -------------- -..Lining material-----------------------_--Depth--------------------------------------------------- ----------- ----- --- ------------ ------ - ---Liquid Capacity----------------------- - Privy: i Distance from nearest❑ well------------------ - -----gals. -------------------------- --Distance from nearest building.--------- -------------- --- --------------------------------------Distance to nearest lot fine_--_------------- ---------------- ---- emodefing and/or repairing (describe)_______________-- --._.- ---•--------------------- - __ ____ _ __________________,-___.___________.___________..________.__.-------------------- _________________________________________________________________ here ertify that I h ve prepay d this applicafifEan and that the work will be done in accordance with San Joaquin County or finances, Sfaf . ws, and les end r dulafions of�the an Joaquin Local Health District. (Signed)------------ By-------------•------------------------------------ —�-- Contractor) ---- R ---------------(Title)__b:4 /• (Plot plan, showing size of lot, location of syste in r a ion a wells, buildir� s, etc., can be placed on reverse side). e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------------------ ------------------ REVIEWED BY DATE-� ----------------------------------------------------------------------------- -------------------------------------------------- BUILDING PERMIT ISSUED----- ------------------------- DATE__.-%,\ DATE - Aaerations and/or recommendations: »-----------------_-_ - --•--------------------- ----- _ _______________________ FINAL INSPECTION BY:-.------------ j� ,� ---------------------------------- Date -------- ._7. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reefI Street 300 West Oak Street 132 Sycamore Stockton, California814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-2M 10-52 Revised W-2100