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APPLICATION FOR SANITATION PERMIT Permit No. A--_3___ _ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Locai Health District fora ' This application is made in compliance with County Ordinance No. 59-9 permi# to construct and install the work herein described, JOB ADDRESS AND LOCATION--_. � Owner's Name-- " -------- - b- ------------------------------------------------- Contractor's ---------------- Phone -G 2+,,1 r Address_.__.- ------ ----- ------- ------- ----- - �--fii--�- ---------- ---------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- -------- Contractor's Name--___�_a-_�� - . ----------- Phone-- Installation will serve: Residence Apartment House ❑ Commercial --•--------------------------- Number -- - -------------•-- Number of living units: _-I_-- Number of bedrooms -.- ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of baths I---- Lot size ---�",Q--_X-----,� Water Supply: Public system r Community system ❑ Private ❑ Depth to Water Table _daft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Gay ❑ Adobe CK, Hardpan ❑ Previous Application Made: Yes ❑ No -New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w .Q/�Sepfiq Tank: Distance from nearest well--------------- Distance from foundation---------------.___.Material ---__---_______ f'� No. of compartments------------- -Capacity Liquid depth Capacity Disposal Field: Distance from nearest well_- - l s.--Distance from foundation_ __-____--__Distance to nearest lot line_-�+-�_--___- Number of lines-----------/--------------- -----Length of each line------.��--!---_---- Type of filter material__ , .. ` �,-----Width of trench-__- _ :,I :8h,----Depth of filter material-----`�_----_----Total length------- +!__-'---- ---------------- 5eepage Pit: Distance to nearest well---el�-._Distance from foundation--_ �f _ _______Distan`0 to nearest lot line_--'14_°_:_- Number of pits-------I------------Lining material__ ---��-'�±---$ize: Diameter------�-�,----____-.Depth------,�-Cr--------------------- 0 '--------------- Cesspool: Distance from nearest well_______________ - .-Distance €rom foundation__________ ________Lining material__---_._----__-_----__.---_ ❑ Size: Diameter------ ------- ------------ --------Del'fih------ --- - ---------- - --- -- - -----Liquid Capacity gals. -' `Priv � - - - Y Disfance from nearest well---------=-----__--_ _ El -___--_--__---Distance from nearest building ..w Distance to nearest lot line---------- ---------- g------------•----- -------------•----- ------------•----- ---------------------------------- ---------------------- ------------ emodeling and/or repairing (describe):-_.-__------------------------ --- - -- e certify - p e his a ca-----•---------------------------------------------------------------------------•----------- •--- I hereby certify +hat f have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. {Signed} -! �1 --oi- - +. Confrac+or) Plot Ian, showin~ size of lot, Iocat ------- ---------------------- 9 ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__0___ DATE_-- ----------------------- REVIEWED BY , -- ---------------------------------------------- ------------------------------- ,! DATE-- BUILDING PERMIT ISSUED-------------- _______ .�------------------------------ ------- ------ ------------- -------------------- DATE---------- A+erations and/or recommendations_ _ -------•- -------------------- ---------------------------- - ----------------------------------------•---------------------- - - - FINAL INSPECTION BY:----- ------ ---- � § . - ---------------- ' ------- Date-------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100