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APPLICATION FOR SANITATION PERMIT Permit No. J._j R (Complete in Duplicate) " Qate Issued __-- --- \TA�plication is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with Count44we�l�Ordinance No. 549. JOB ADDRESS AND LOCATION_.__ Owner's Name---------------------------- r l u--------------------------- Address-------------------------- ----------Address------••------------------ is, .foo S71r---72'_A -- ----- Contractor's Name-------------------------------�P_Vt1 - e1. - Phone. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ed f Number of living units: __� Number of bedrooms ___I__ Number of baths ___ __ Lot size .____ Water Supply: Public system 21 Community system ❑ Private ❑ Depth to Water Table Vie}ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No JX New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewers available within 200 feet.) T No. of torr artments--°---------------- i --Size-----=------------------------Li -----------•------.Material--------- ----=- --�--- ---------------------- S is Ta Distance from nearest well___________ ____Distance from foundation quid depth_____�___.____ sCapacity______________________. Dis al Fi I : Distance from nearest-well-------_--- ----Distance from.foundation ______ Distance to nearest lot line_________________ y.� Number of lines_____________ _ ----- ----------------------Length of each line�_------- -- --------.Width of trencft------�----------- - ------------ ar filter material---------- _______`__-Depth;of filter material'_ ____..______._._Total length__--------- Type ____.__.._______________.- a e Pit: Distance to nearest well- Distance fr m foundation=_ ®� p 9 - - _______________.i]istance to nearest lot line_._/4`_-- ee Number of pits______h______________Lining material_ 'e�- 4 It -Size: Diameter_131!---.--__Deptn__•Z.rJe ----------------- _ Cesspool: Distance from nearept well-----------'.___Distance-from foundationt------------------ Li ng material---..__J--------____-__.__.____._ ❑ Size: Diameter--------------------------------- ----Depth ---- ---------------Licluid Capacity----------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_+___.__.--_A-------------------------- El Distance Distance to nearest lot line - 11----------------------=---------- -------------------- Remodeling and/or repairing (describe):---------------------- ------------------------------ ------------------------------------------------------ - j ----------•-•-----------------•-••---------------- ----•------------------•----•------------ ----------------------•------------------- —{ ----- -----------------------------------•--- - t ------------------------ I hereh .certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance , ate laws, ayo rules and regulations of the San Joaquin Local Health District. � ' --------- - ----- - Contractor)(S. (Signed). ---------------------------- - - --- ---- - ------ By:.---•---------------------------------------------- -----.=-------------------- --- - -- -- -- --------------------------(Title)-- (Plot plan, showing size of lot,,location of system in rely in to wells, uildings, etc., can be placed on reverse side). r � I FOR DEPARTMENT USE ONLY E APPLICATION ACCEPTED BY---=�"' .`„-- --- -----------------I------'^DA TE REVIEWED BY ------------ = - = `DATE ------ - BUILDING PERMIT ISSUED----�-----,—.I---------------------------------`----------------------�-------------------- DATE------------------- .. Alterations and/or recommendations:----------------------_------------------ ---------------------------------------•------------ ------------------------------------...-------------------------------------._..._..---•--•----------------•---------------------------------------------------------------- i - - --•---------------•--- -------------•-------------- ------ - ----------------------- -- -----------------------------------------------------.----------------- ------------ -----------------------------------•- -----------------------------------•--------- ------ -------------------------=-------------------------------------------------------------------------------- ----------------------------- -------------------------- ------------------------------------------------------------------------------------------------- --- --•----------------------- '-----•--------------------------------------------------------------------- i ' 1 FINAL INSPECTION BY--------------------- l----1` !__��.-------- « - - Date---------------�- --- - � SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street, 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M i0-52 Revised W-2100