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:> fle --& 16v,�A 3 =, APPLICATION FOR SANITATION PERMIT Permit N' .�_ 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. 549.9 ' JOB ADDRESS AND LOCATION------ `� r Ys' ```' -o�' --------------------------------------------------- Owner's Name ----------------------- - 9 - C -5 1f Phone . -.4- ------------------------ Address . Address--------------------------------------._...------ --------------' -----------------------------------------I---•------------------------------- --------------------------- Contractor's Name------------------------------ ---- --- -- —- ----- �'�r-�r---------------------------------------------- Phone---17-_--may---4_-.'------- Installation will serve: Residence 'Apartment House [] Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ �� i Number of living units: J----- Number of bedrooms ___ 1qumber of baths ._.1___ Lot size --------___-___C7_ ------- ------- Water Supply: Public sysfernX Community system. ❑ Private ❑ Depth to Water Table 4cv t. Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam ❑ Clay Loam /❑ Clay ❑ Adobe, ( Hardpan ❑ Previous Application Made: Yes ❑ No 1%� New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted if public sewer is available within 200 feet S c�T k: Distance from nearest well_ -__-Distance from foundation_ ----Material___�-------------------------------------- g_ No. of compartments--------------------------Size--------------------------------Liquid depth------------------------- Capacity------- --------- —v Di sal ,keld: Distance from nearest well.................Distance from foundation________--________.Distance to nearest lot line-----------------'' Number of lines___________________________________Length of each line_____ _ - ----- ---- ---------Width of french---------------------- --- --------- Type or filter material-------------------------Depth of filter material______________________Total length---------------------.-------------------- Nk Seage Pit: Distance to nearest well.NJOW��-----Distance from foundation__&_9 ` nearest L t__ ___ Distance to line...eeg Q.{F_ Number of pits______ ______________Lining materiaLGCI��(�.__.Size: Diameter�.3_...._.____.Depth_...__.+�__ ____. ��__� Cesspool: Distance from nearest well-----------------Distance from foundation--------------_---__Lining material---__-l,_...-.---_.-_..._____________ ❑ Size: Diamefer--------------------------------------Depth------ ---------------------------------------------Liquid Capacity-----------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearesr 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, a laws, and rules and regulations of the San Joaquin Local Health District. (Signed).._--- C,iI�1L(< -- :C.,.�----------------------------- -- - ---- - ----- --Pbuilldin ------------- �F '- Contractor) plan, showing size of lot, location of system in rela o .- - �---- - --------------- (Plot _._____..___.__.___..____ Y p g y n to wells, s, etc., can be aced on reverse side). FORDEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -----------------•-------------------------- y --------------------------- DATE-------------------- ;�5�----------------- REVIEWEDBY---------------•---------- ---'-'------'--- -------------------------'---'----------------�--------------------------------- DATE---------------------- ----------------- . -------------' BUILDING PERMIT ISSUED_. DATE----------------- ------ - -------------'--- Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------'------------------ ----------'----------------------------------------•---•--•------------------------------------------------------------------------------------------------------------------•---------------------------••------------------- FINAL INSPECTION BY______________ ------------------------------- Date_._r..:._: _.: 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-9-2K1 10-52 Revised W-2100