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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) f-------------- Date Issued Apli tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descr'ibed. This a plication is made in compliance 'A C jy W, I oun ante No. 549 JOB ADDRESS LOC TIO A__/---& --- ------- ------------------------- --------- -- Owner's Na 9-4&C ------------- ----- = wow------------- Address---- ----------- ------- --------------- ---------------------------------------- --- Phone -- --- - -------- -------- --------------------------------------------_---------------------------- Contractor's 'Name--- --- - ----------------------------- Installation will serve: Residence Ap -------------------------------------------------------------------------------------------------------- Phone.................................... arfment House E]? Commercial El Trailer Court Ej Mot Number'of living units.- umber ❑ of bedrooms 10 Fj L1 Other -- ---- __; Number of baths P Water Supply: Public system ;��mmunity system Ej Lot size ----------------------- Character of soil to a depth of 3 feet: Sand Private El Depth to Water Table ---I---- ft. -Z Gravel [] Sandy Loam' V]o Clay Loam Clay El Adobe W-/Hard'pan El Previous Application Made. Yes No E110—New Construction: Yes V N ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ❑ (No septic tank or cesspool Permitted i#rbl*c $ Sepflc.A-.(ank: Distance-.1 from nearest wellrl�V er Is available within 200 feet.) isfanFe f f ;daf;on/,0'? M A ..... 1 YN No. of compartments__,__.-_ ater-aj -_ --- - - ------ S i zz.x -------Liquid depth----------- ----------- ----_-._-__Capacity - _0_0------- Disfance from nearest well------------------Distance from foundation-------- ' lines------- - ------- Number of ----------------- ----Distance to nearest lot line Type of filter material--------- ------ ----Length of each line---------____-- �Widfh of trench------------ --------- --------- --- --------- -k Seepage Pit: Distance to nearest well_."_-______ --.--Depth of filter material-----------------------Total length----------------.......................... --------Distance from foundation__"________________Distance to nearest [of line_ 171 Number of pits-_-------------------Lining material-----------------------Size: Diameter____---_----- ------------------ ----Depth---------------------- P ---------- El Distance from nearest well-----------------Distance from foundation__---__:-- -------Lining material Size: Diameter--------------------" -"-- ----------.Depth--------------------------------------- - epth------------------------------------------ ---------Liquid Capacity------------------ ---------gals. Privy: Distance from nearest well----- ----------------""-_ - Distance from nearest building__._------------------ El Distance to nearest lot line P elfin and/or repairing {des - -------- - ------------- ---- -------------------------------------------------------------------------- ---- ------------------ -------------------- ---------------- ------- ------------------- - ------or-------- -------- ----------------------------------------------------- .....Zf certify the+ I have prepared this application and frhna'f the work will be done in accordance with San Joaquin County I hereby c 1AZZ S. * , ordinance S ate laws, and rylls and regulations of J a quin Loco"will I I District. (Signed)------------ -------------- --•------------------- - ------ ....... . By:----------------------••-----•--------------------'--------- ------------_--_-........................ . ...... ...... ----- -----------------------------------(Owner and/or Contractor) --------------------------------------------------------------------------------._(Tifle)--------------------------------------------- ----------------- (Plot plain, 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:::--- REVIEWED BY P i— --------------------------------*----------------------- DATE---:;;V ------------------ BUILDING PERMIT ISSUED-------------- DATE -----------I------------------ ----------------- Alterations and/or recommendaf ions: -------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------- ------------------------------------------------------------------ --------------------------------------------------------------------------------------------------------------------------------------—-------------- -------------------------------------------------------------------------- ------------------------------ ------------------------------- --------I--------------- ------------------ ------ -------------------------------------------I---------------- ----------- -------------- --------------------------- ------------------------------- --- ----------- FINAL INSPECTION BY------- ----/-*W ;-) ------------------------ -------------- Daf....../ --� ------------------- ---------- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, CaliforniaLodi, California 132 Sycamore Street 814 North "C" Street Manteca, California Tracy. California ES-9-2M 10-52 Revised W-2100