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y APPLICATION FOR SANITATION PERMIT Permit No. .._CI"' (Complete in Duplicate) Date Issued ____��_Q_!•a fCpplic:anion is hereby made to the San Joaquin Local Health District fora permit t This application is made in compliance with County Ordinance No. 549. p o construct and install the work herein described. JOB ADDRESS AN CATION_ _f, J--A .----So--.��t�-s'rr~.r--------------- Owner's Name---- __ .j �>_--_- - - --- - - - --=-- -- --•----------- - - ---�---------- Phone-----------------------•------------------- •----- ` {�/��-=- _ Contractor's Name____________________________________--__ ---- ----------------- Phone Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _/____. Number of bedrooms ' _� Number of baths ___�__ Lot size _ L--- --� -------------------- Water Supply: Public system $�_ Community system ❑ Private ❑ Depth to Water Table W'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan E]Previous Application Made: Yes ❑ No)< New Construction: Yes'9No [] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tc Distance from nearest we!!_" 4___Distance ;rom foundation----.�_ --_----. --- ----- --------------- -- No. of compartments_.__" Size__ ��-- Liquid depth__.------_. _ _ Disposa)eField: Distance from nearest well_~`r'-"----Distance from foundation_-�_0----------Distance to nearest lot lin _-- - � 1 � Number of lines__-.----------- Length of each line �f, 9� C�- 1/ti/id}h of trench_____a _ __ Type of filter material-____ Depth of -Filter`material_.._ ..��--->-Total length___.___- ---- --- , ---------- -- --------------- Seepage;it: Distance to nearest well__________"___.Distance m foundation _ _ ---------Distanw to nearest lot l' Number of pits----- material-- _.Size: Diameter_-_ _ f Depth... - --------- cesspool: Distance from nearest well__._-------_----Distance rom foundation--------------------Lining material----------____________________ ❑ Size: Diameter--------------------:--------------- Depth------------------------- Liquid Capacity gals. V Privy: Distance from nearest well.__--___�_•_-- "-_ ,�_Distance from nearest building❑ Distance to nearest lot line--- ---------- - 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- ------ 17, ---- ;. - [Owner and/or Contractor) By:---••-------------------------•---------•---------------- ---- - ------------------------------------------------------------------(Tit le)----------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- DATE------- ------------- ------------------------------ DATE------REVIEWED BYO . - r ?• --------------1-�- BUILDING PERMIT ISSUED----------- -- --- ----- DATE _" " -------------- Alterations nd or re men s---------- Q _C _ _--- � yy ` - __ ► ------------------- x 41� = mnf_�- �► f y ..-- _M K _ '��. ►r A4 -Y• . E_A r FINAL rINSPECTIONBY------ ""--( ----------"----- r Date-------- el S JOAQUIN L C L HEALTH-DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-21A Revised W-2100