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APPLICATION FOR SANITATION PERMIT Permit No.—?.f_ -• 1 (Complete in Duplicate) Date issued Application is hereby made to the San Joaquin Local Health District for a perm-t to construct and install the work herein described. ' This application is made in compliance with County Ord, rice No 5 JOB ADDRESS AND LOCATION_______--- d---- ---A------ - -- -- --•4----1------- - - --- -- -- -•�- -- - ----_---- --- - � Owner's Name------------ ---- -- -- ----•-------------------------•---------------------------------------------- ------------/------------------------------ Phone------------------------- ------ - I Address---------------------- Contractor's Name - - • ------ hone------- --- ". ...' Installation will serve:' Residence ❑ Apartment House ❑ Commercial ❑ Trailer.Court ❑ Motel ❑ Other s Number of living units: ________ Number of bedrooms ______-. Number of baths --46-- Lot size ------------------ - Water Supply: Public system 0 Community system ❑ Private A---D*epth to Water Table ________ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe arcipan ❑ Previous Application Made: Yes ❑ No Ej--`New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No(septic tank or cesspool permitted if public sewer is available within 200 feet.) a Septic T � p �: Distance from nearest well________,_______Distance from foundation___________________.Material__.--------- ._________-.__-,______,.______.__.-. £- No. of compartments.. - Size Liquid"rdepth---------- -- -------------Capacity-- ------------------- Disposal 'eld: Distance from nearest 1�_1100 i--Distance from foundatio�_►Z,�_____._-Distance to nearest lot line Number of lines_______`-. -� Length of each line___E p - -------------- Width of trench.---- -----------------------.- Type of filter materia_j. --&,----Depth of filter material___.j_�:--- -------- length____ca __ . Seepag i Distance to nearest well_____________________Distance from foundation________-___..__.-..Distance to nearest lot line______.______._ Number of pits -------------------Lining material------------------ Size: Diameter--------- ------------.Depth---------------------iz -..------ Cesspool: Distance from nearest well-----------------Distance from foundation______________ Lining material-___.___________--_-_____________- El_ Size: Diameter--------------------------------------Depth.) _; -_ r Liquid Cap�.a,c,�Y—__.__-. ;_ . __gals: T . Privy: Distance from nearest well- ___-__- _ _____________Distance from nearest building _-.- ❑ Distance to nearest lot line- ------------ ------------ -------- - Remodeling and/or repairing (describe)---- ------------- - .__.____ __ - --------- I> 11.1 --------------------------------------- ------------------------------ ------ -----`---------------------------------------------------•--------•------------------------------------ ---------- E I hereby certify that 1 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. (Signed)------------ - _ --- ----:f- ...... 0�. �]� ---------- r ontrac+ ) --- ---- - -- -- - --- ---------- --�- -- --- ----r--- --------- - wne and/or or BY= -----------------------{Ti+le)--- "'L - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . 1 APPLICATION ACCEPTED BY------ ------------ - --- - --------------- --•----------------------------------------- DATE------------ --------------- ---------- REVIEWED BY---------------------------------- -- - ------ - --------------------------------------------------------------------------. . DATE----------- 7 r Z BUILDING_PERMIT ISSUED----------- zt_= '----- HATE__ =• �. = __ — µT r;--�. -- = T ------ ---- .: -- - AI#erations and/or recommendations: -------------------------- ----------------I-------- ---------------------------------------------------------------------------------------- ----------------•-------- •--------------------------------•------•-----------•---------------------------------•------------------.------ ------------------------------- ----------------------------------------- ------------------------------------------------------------------------------------------------••--------•----------- ------ =------------------------------------ ----------------------------- -------------- -- •--- ----- ------------------------------------- ----- FINAL INSPECTION BY--------------------------- ----- ----------- f Date _ SAN JOAQUIN LOCAL HEALTH DISTRICT ` 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 10.52 Revised W-2100