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a e2�/: o n G+. � .APPLICATION FOR SANITATION PERMITPermit No.1V1_eZ1_._19--- _ r3~ 'P, ! - d` ? --- (Complete in Duplicate) /*I Date Issued cy,f7- /S-/--Is Application is hereby made to the San Joaquin Local Health District for a permit to con truct and install the work herein ibed. This application is made in compliance with Cou y rdinan No. 5 ""�- I JOB ADDRESS AND LOCATION_ � .�- - -s''` , F 1 l 1 Owner's N - A " .�------------------- Phone_ + Address-- % •---- ------ 13k Contractor's Name ` It •- -- - {a Phone > - 0 --- - - -- - - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: dumber of bedrooms 4--`Number of baths ----- Lot size =2jR9__K ------------------- Water Supply: Public system ❑ Community system ❑ Private [� Depth to Water Table_ ft. Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy✓Loam ❑ Clay Loam ❑ Clay E] Adobe Hardpan ❑i Previous Application Made: Yes El No L New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well------------------Distance from foundation--------------------Material ________________._____________-_ 1 No. of compartments--------------------- ----Size--------------------------------Liquid depth----------- ----- Capacity----------------------- Dis o al Field: Distance from nearest well __ n_ Distance from foundation__,, _ Q vq ��/ ___Distance to nearest lat ine_ _________ Number of lines---- -- Length of each line___-` .Width of trench_ -- 0 ------------------------ r Type of filter maferialf(��j�------Depth of filter material____`_____-___Total length_``__`- ------- � P Se a Pit: Distance to nearest wefl _ _-.___Disfiance m fQ dation .___-_-.Distance to nearest to line_ f1 h Number of its_��—_ Linin material__ Size: Diameter__ p -------- g - ��,�1---_ Depth ------------------- Cesspool: --`----------- --- p Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material------------------------ ❑ Size: Diameter----------- ----------------------- Depth---------------------------- ---------------------Liquid Capacity---------------------------gals . Privy: Distance from nearest well_______________ __.___Distance from nearest building El Distance to nearest lot line__________________ Remodeling and/or repairing {describe}:_ --- -------------------- -------------------------••-------11---------------------------------- ''��` F - -------------•-----------------------------------------------------------•----------------------------------------------------------- ------------------ ---------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------- --- . I hereby cer ' y hat I have pr red this applicafion and that the work will be done in accordance with San Joaquin County ordinances, Sta law , a rules an regulations o the S Joaqui I,Health District. (Signed) c - (O -------- wneh an Cont actor) By:------------------------- `-------- _ - {Title)-- - a --- ---------- - - - ------ ----- (Plot plan, showing siz o+, location of system in relation o wells, buildings, etc., can be plat d on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------- - ------------- -------- ------------------ DATE----- REVIEWED BY_______ ------------------ DATE__ BUILDING PERMIT ISSUED_______--�______ _ - ------------- ------------------------------------------------------ ---------------- ------ DATE-- -- ------- -------------------------------------------- Alterations and/or recommendations________________________ ----------------------------------------------------•--------•----------•------------------•-----•---------------------- ---------------------------�-•---------------------------------- FINAL INSPECTION BY:- ✓ - -- --------- --- �--�----a-- ' Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" S}reef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100