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41''APPLICATIONFOR SANITATION PERMIT Permit " ' r (Complete in Duplicate) — •, .. M Date Issued " Applica+ion is hereby mode 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 O; inane No. 549. JOB ADDRESS ANDge --- ---_` -_•-- -_ �_ -Owner's --,�--------------------- -------- ------------------•------ �--- --- ---- Phone__.------- -------•-------- Address ------• � --- - -------- Contractor's Name--- - ----------- Phone.---••------ ------- Installation will serve: tment House ❑ll Commercial ❑ Trailer Court [] M?tel ❑ Other, Number of livingunits: _:f___ W umber of bedrooms _1____- 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'E] Gravel ❑ ❑ E] E]Sandy Loam Clay Loam Clay Adobe Hardpan El Application Made: Yes ❑I No E] New Consfruction: Yes El No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) x Septic Tank: Distance from nearest well________ ______Distance from foundation--------------------Material___________- ____-_____- ❑ No: of compartments---------- ---------- ----Size------•------- --------------------- - -----_--•------Liquid depth----------- --------- --Ca Capacity Disposal Field: Distance from nearest weli__-------------___Distance from foundation--------------------Distance to nearest lot line_-______- ❑ Number of lines-----------------------------------Length of each line----------------------------..Width of french Type of,filter material___._______..__-_.______Depth of filter material___________________-_-Total length____________ ..___ --------------------- ' p .9we-ll--' See a e Pit: Distance to nearest ______--~_______Distance from foundation___________________Distance to nearest lot line______ ❑ Number of pits.--?------------------Lining material-----------------------Size: Diameter------------------------ Depfh-- -------------- 1-1 Cesspool: Distance from nearest well-_______________ Distance from foundstion____ -_-___.__.___.Lining material-- ❑ Size: Diameter-- `---------------- ---- Dept .Liquid Capacity t � 9 Privy:/ Distance from nearest well__ �__----- -- istance fro nearest buildin Y Distance: est;lot line'_ -- r r 9 `- ,► ----------------- -- Remodel•ng and/or-repa rn fodescrF ------ ---•-- -- - -•----------= :. ,-- ------------- -----1 ----- ------- ---l---------- ------------------ t ;y -------- '�y -•-------- --------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqui ordinances,, Statdiaws,-and n County ules and regulations of the San Joaquin Local Health District. 1 { ----` (Signed) +-•-------------- (Owner ' -------------------•-------------- ------------ ----------�-- --------------•----------------- ------------ ------------- -O and/or Contractor) By: ---- --------------------- [Ti+ 3 le)---------------------------•------------------- (Plot plan, showing size of lot, location of.sysfem in relation to wells, buildings, etc., can be placed on reverse side. I ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYS-4 ------ - -_ DATE - -----------• REVIEWED E I IS -- E - -- ---------------------------------------------------------- -------------------------- DATE__ ------------ BUILDING PERMIT ISSUED. --------------------------------- DATE-------- ---------- Alterations and/or recommendations:_-:-`__.-_____. ---------------•---------------••------------•• - ---------------------------------- R� ' FINAL INSPECTION BY:- --------------------------------- Date------ r -------------------------- ------- ------------••------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ' Revised W-2100