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APPLICATION "FOR SANITATION 'PERMIT Permit No. .._3.S...(0, ti (Complete in Duplicate) aa �. Date Issued -------------- Application =---/-_-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 Ord' ante 549. JOB ADDRESS A LO TION ' NV --------- ------------- �. t --------- Owner's Name------- ' ., - ----- ---- ------------ ------------ Phone a Address . ` Y L�,�1 ----- Contractor's Name__. ____._ _ i � f Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailekr Court ❑ er❑ �F ❑ /Motel p Oth Number of living units: __ ____ Number of bedrooms . �__. Number of baths Lot size 6 ._ 7 Water Supply: Public systemCo mmunity system El-..Private ❑ Depth to Water Table -------- ft. Character of soil �-t'o� depth of {em-San Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Applica ,if on Made: Yes ❑ No New Construction: Yes VNNo ❑ ' TYPE 61`114S LLTION AND SPECIIFICATIONS: (No septic Tank or cesspool permitted i ublic sewer is available within 200 feet} ' �� //� Septic ank; Distance from nearest wellistc�nce fr fo dation/"1� Mat rif - No. of compartments ize ""_ ' _. Liquid +depth- '- Capacity L�--O _ I r - Dispos Field: Distance from nearest w ll__ " " _ Distance from foundationA _ ' I f ___. __ Distance to nearest I t li ell Number of lines___________ __ ___ Length of each line______ __ Width of trench.__ 21----. Type of Flier materi ___ � epth of filter material ______j_ _ ---iTotal length 9 �-------------•-----"---- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------_-----------_Distance to nearest lot ❑ Number of pits----------------------Lining materia)----------------------.Size: Diameter-----------------------Depth------ --------------------- - Cesspool: Distance from nearest well-----------------Distance from foundation______________" - __ .Lining material Size: Diameter Depth ---------------------------------Liquid Capacity ---gals, Privy: Distance from nearest well_______________________________.._____--------Distance from nearest building❑ Distance to nearest lot line '___________________ R mod ing 4/or repairirLg�( escribe :"" ------ --------------------------------------- ------ --- c I hereby ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,/and rules and regulations of the San Joaquin Local Health District. 4 Si ne ._ --4r " (Signed).- gd} JOwner and/or Contractor){ -------------------------- $Y� ---- Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i I FOR DEPARTMENT USE ONLY e. APPLICATION ACCEPTED BY ____________ ___ _______.___________- DATE REVIEWED BY `---------------------- - -- ------ --------------------------------------------------------------------------- DATE_-..Q- BUILDING PERMIT IS5LIED----------------------------------------------------------------------------------------------------- DATE-- 'fit, Alterations and/or recommendations__________________________ I ------------ - -•-----------------------------•-------- ---•-------•-------•-------•---•--------------------• -------------- -------- ------------ FINAL INSPECTION BY-------- ------------•- --------- ----------- 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 10-52 Revised W-2100