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APPLICATION FOR SANITATION PERMIT ermit 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""11 ,V-u., s J Owner's Name_______________••_"_ - SA ---------------------------- ------ - Phone--- p y Address ." Contractor's Name--- ----------------------------------------- ------------- --�..-------•- ----------------------------------- ------- --------------------------------- - --- •-•--- ---------------- Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court Phone"__. tel"]_a? Number of living units: -/"--" Number of bedrooms ❑ Motel ❑ Other ❑ Number of baths " -- Lot size Water Supply: Public system Community system � ------------------------- Previous ---`--'"""-" ' PP y• � i Y Y ❑ Private ❑ Depth to Wafer Table _loft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay1t Previous Application Made: Yes ❑ AdobeK Hardpan ❑ ❑ !No � New Construction: Yes.❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: vG o septic tank or cesspool permitted if public sewer is available within 200 feet.} c Ta � Distance from nearest well-----------------Distance from foundation__"__"-__"_"-_-._ Material "-_._____._____------------------------------- ------------------------------- ____- (`�•� No. of compartments--------------------- ----Size Liquid depth-- - a - --------------------- _ _ t ------- --Capacity.------------ Sp-sal-F*MFJi� Distance from nearest well_- .-Distance from foundation_ ___--__ ® Number of lines-,,/: 1 Distance to nearest lot line--_- ''? Length of each line"_-_ ------------ Width of french... 7�!�c��. ,�. Type of filter material_-1__ -" 1------Depth of flier material"-_�""r ""__-_ ------------- rt _ Total length"._3-_,A ----------- -------- Seepage Pit: Distance to nearest well"_gz&�--_--Dis nce frzm`'foun j ..Distance to nearest lot line-_"- -_" Number of pitsL----___-----_Lining mat rial_ �J ¢e: Diameter___ Cess aoL t -- Depth---a-.1--------------- p Distance from nearest well--------------- Distance rom foundation__________________ "" - Lining material----------------------- --------Diameter-- ------- ---- --- ---- --- ------Depth----------------------------- ------ ------ ----------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--_--"._-"_---"------------- Distance from nearest building_"-_-"_----------------------------- I ----------_ ❑ Distance to nearest lot line = -----.- "-.._.._. -------------------------- -- - --------------------------------- Remodeling and/or repairing fdescribe):------------------------ } --------- --- - - -----•----------------------•--•-•----•---•--------------------•----------------------------------------------- -•---------------------------------- ----- --------- -------------------- ------------•-- _ I her6by certify fhat ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an ules and re gu tions of the San Joaquin Local Health District. (Signed)---------- ---------- ------ ------ -------- - -- -------- --------- -------- -------- --- -�----- d,�oF Contractor) 8Y= ------. -------- - ,I�,�, -� -------------- Title ! (Plot plan, showing size of lot, locafio .a em in relation to wrs, buildings, etc., can be Aac6d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ___-" ---------------------+ - DATE---------- = REVIEWED BY--------------------------------------- p� BUILDING PERMIT ISSUED - -- - ------- DATE - --------W--------.- " --------------- Alterations and/or recommendations------=--------------------- --------------- ---------•-------- -- -------------- DATE- -------- -------------------- -------------- --------------- ------------------ --•------------------------- --------•---- --•---- -------------------- - ----------------------------------------------------- INSPECTION BY Date- --------------------------- SAN -------------------------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American StreetI Stockton, California 300 West Oak Street 132 Sycamore Street 814 North "C" Street f Lodi, California Manteca, California Tracy, California ES-9-2M W-sz Revised W-2100