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R APPLICATION FOR SANITATION PERMIT Permit No. .--�-d_S- (Complete in Duplicate) _ Date issued ----------------------- Applica�ion is hereby made to the San Joaquin Local Health Dist rI for a permit to construct and install the work herein described. This application is made in compliance with County Ord' ante N 549. JOB ADDRESS A OCATION_---_ -, _ _- _ _ _).--- Owner's Name. Y --r� ------------- ---- Phone!!-[ - f ,� Address-------------------•---- _ Contractor's NameL �7--�------ - Phone .. ,Q- -. ------------ --- Installation will serve: Residence g--A-`partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j--.- Number of bedrooms 17 ` Number of baths .- _.__ Lot size ---.-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91-Kardpan ❑ Previous Application Made: Yes [] No E9-'__N'ew Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) soi� stance from nearest wek-__-------------Distance from foundation__------- --.------.Material----------_._------_ No. of compartments------ --- ---------------Size---..-------------------------_Liquid depth-------------------- Capacity Disposal Field: Distance from nearest we1f. Mme_Distance from foundation,-49_--------.Distance to nearest lot line.... Number of lines------ -___-- Len th of each line �--�j-�- t 9 -c�-r-1�-----•- it----Width of trench.-�-,�--- ------------ Type of filter material--- �U1 Depth of filter material------- --------Total length--_ Q_ _____________________ Seepage t; Distance to nearest well- ----Distanef undation-_�,�__7-.Distance to nearest lot line ___ '7 Number of pits..-.-/--------------Lining materia -----Size: Diameter-_-3_3 f_r-----.Depth -.�' - - Cesspool: Distance from nearest well-----------------Distance from foundation------------ material---.___.-__-__---_.----_--_----____ ❑ Size: Diameter--------i-----------------------------Depth------------------------------------=--------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------"--------------------------Distance from nearest building------:-- --------__-----_.-----------.-. ❑ Distance to nearest lot line------ ---------------------------------`-- _ - Remodeling and/or repairing (describe) ------------------------------------------------------------ ---------------•---•-----------------------------------••-----------•--------------•--------------------------- ------------•------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ -------- ------ - ------------------------------------•---- ------------•------------------------------------------- •--------•--•---•--------------------------------•----------•--------------------- I he -y certify A I have prepared this a 'cation and that the work wil a done in accordance with San Joaquin County ordinance , , and rula� d regulations of a San aquin Local H Ith District. (Signed)--------- ------- ------------------------ -- ------------ ------- ------ - --- ---- ontractor) 1By: --------------- ----------------------- ----- ------ - ------ - --- -- --------(Title) ,C��ris- ----- ------------------------ P of plan, showing size of lot, location system in relati to wells, buildings tc., can be paced on reverse side). DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- DATE-_,--------____-_-_- REVIEWED BY------------------------------ DATE BUILDING PERMIT ISSUED ----- - - ----------------------------------- DATE------ Alterations and/or recornmendations:_ -:---------•--------------•----.--------.....--------.---------------•----- •----- ••-------•------------•---------------- -------------------------- --------------;------------------------- ---------------------------A--------------------------------- ------ --•- ---------------------------------------------------------------- -----------•-----------•----------------------------------- FINAL INSPECTION BY% �-lt��--------------------------- � Date �-------r--�-�----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sheaf 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; - Revised W-2100