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APPLICATION FOR SANITATION PERMIT Permit No. --------------- ... (Complete in Duplicate) 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. 549. JOB ADDRESS AND LOCATION------- ------ -°---- -+--v�Z.QtF------------ ------ - -._ -a -- -- -----------------------------/---/--------- Owner's Name------------------••-----------------j-4474-g .z_. Phone jr Address---------------------------•-------•----- -Q '?go /� Contractor's Name------------------------ •d�.(rr�� _R_�S.[ ¢ n_ - - ------ Phone----- 4 ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units:____ Number of bedrooms__ Number of baths_ Lot size ___6__ _1_ -�I _ ____ � { Water Supply: Public systemCammunity system E] Private E] Depth to Water Table ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobHardpan ❑%.4 Previous Application Made: Yes ❑ No�New Construction: Yesj�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' tic TDistance from nearest well-----------------Distance from foundation-------------------.Material-_-_______________________________._--_________- No. of compartments-- ----Size-------------------------------Liquid depth--------------------------Capacity----------------------- - Dispo I Field. Distance from nearest well__.�fl� �Distance from foundation---0- -_--_-Distance to nearest lot line_-_��_____ - Number of lines_---------- ____ _ �� JZ rt_�_ �_ __--Length of each line------------- --- ---.Width of trench---------------�,tC_.-------------- Type of filter mafieriaLj- ____�`S_-_-_Depth of filter material___--�,�_____-___Total length____Ce11-r Seeps a Pit: Distance to nearest well_�,T?R,6'---.-Distancfou dation_ -D`"-__Distance ro nearest lot line_ Number of pits___________.-_---__Lining material_ -Size: Diameter__._5_r3-,-.____Depth------ ---------------- l Cesspool: Distance from nearest well----------------- from foundation-----------.--------Lining material-------------------------------------- EJ ________________________-- ________.❑ 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):---- A ------- ------- - JO - -------• -------- -- ---•--- --- - - f%�_ ... - �^ -- --•---------•---------------- ----------------•--------- ------------- ---- --- ----------------------------- ------------------------- ----------------------------- -------------•------------------•------------------------------------------------------------------------------------------------------------------------------ hereby certify that I have pr ared this applica ' and that the work will be done in accordance with San Joaquin County ordinances, Stat law r es d regu! 'ons of a San Joa in Local Health District. �c (Signed) rlkl� { ------... . y ................................ frac#or) ... ....;r`3 -�------ ------------------------------------------ e rC n -------------------------(Title)-r- A - - - ---------------(Plot plan, ing size of lot, location o sys em in relation to wells, buildings, etc., can be pln reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE �-------------------------------------------- REVIEWED BY - - - -------------------------------- ----------------------------- DATE------------ BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- ----------- DATE --- Alterations and/or recommendations:--------------------------. !moi.;__, .4-4---------- --- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------- •------------------------------------------- ----------------------------------------------------------------- -------------------------------- --------------------------------------------•-------------------------------------------------------------- FINAL INSPECTION BY:----------- - --------- ----- -------------- Date---------------�----- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California E5-9-2M B-51 Revised W-2100