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APPLICATION FOR SANITATION PERMIT Permit No. ---(•. «5 (Complete in Duplicate) Date Issued t--- �-� Application is her y made to the San Joaquin Local Health District for a permit to construct and install the worn herein described. This application is made in compliance with ,County Ordinance No. 49. JOB ADDRESS AND LOCATION-----_ _- - --------------------------------•------- Owners Name ' - - - Phone Address------------------- • ------- -- -- - 41 Contractor's Name---- - ----_,. Phone Installation will serve: -Residence Apartment House El Commercial (3o Trailer Curt ❑ Motel [I Other ED Number of living units: _-_I-- Number of bedrooms -t.. Number of baths __l-_ Lot size ----:��- - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �rft. . Adobe ardpan ElCharacter of soil to a depth of 3 feet: Sand ❑ Gravel ED Sandy Loam ❑ Clay Loam [I Clay ❑ Previous Application Made: Yes ❑3`No � Construcfiori'Yes No ED TYPE OF INSTALLATION AND SPECIFICATIONS: s ` (No septic tank`or cesspool permitted if public-sewer is available within 200 feet.) -# Material-.-==:------------------------------------------ Septic 7ank:� F Distance from nearest well-----------------Distance from foundation-------------------- -------------- -. Capacity-_.----_ ! Liquid de fh. No. of compartments------------- ------------Size ----- q p. Disposal Field: Distance from nearest well Distance from foundation--------------------Distance to nearest lot line----_---.------_- . Number of lines- ---- --- "�" -«'Length.of each line------------------------------Width of trench--------------------------------- ` ype of filter material------------------------- epth of filter material--- ___.___--- �---Total lengfih-------...___.------------------ -oe .--.Distance to nearest lot line--./"5 -_._. Seepage Pit: Distance to nearest well-/ - _:DistancdeotC rom foun 'ation__-., �_..- �+ Linin ma#erial._ - Size: Diameter---------P4 Depth----- Number of pits- ---_- -- g , Cesspool: Distance from nearest well-----------------Distance from foundation---------°----.---.Lining material----------_--_--------------"-- ---- ❑ Size: Diameter------ ------------------------------Depth-------------------------------- ------------- -----; Liquid Capacity 9 j Privy: -------- -- Distance from nearesf building---------------------------------------- Distance from nearestwell----------------- Distance to nearest lot Iine----------------------------------- � I ---- - ------------------- --- --------------------- --•------------------- Remodeling and/or repairing (describe):: --------- } ------------------ ------ --- 1 •-----•----•---•------------------- -------- � a ------------- r - - ------------- - - ------------------------------------- -------------- --------------------------------------------------------------------------- --------------------- ------------------------------------------------------------ i 1 hereby certify that l have prepared this application and that the wo will be done in accordance with San Joaquin County ordinances, State ws, nd rules;'and gulatio s of the S n Joaquin Local Heal f1 District. ]] e 4 R t 1 -,- (Ow nd/or ac ne C`tr ar I (Signed)-- d r ,- . --------------------- � (Title) (Plot plan, showing size of lot, location of system in relation,to wells, buildings, etc., can lie placed ori reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ----------- ! DATE-------------- ,$� ---------------- DATE------------------------------- -- ------------------------ REVIEWEDBY----------- ---------------- ------------- ----------------------------------------- - DATE-------------- ----- - BUILDING PERMIT ISSUED -------------------------------- - ------------------------------- Alterations and/or recommendations:----------.----------- ---------- i ----------------------------- pp' - 6 Date---------- � - ------ ---------------------------------------•-------------------- FINAL INSPECTION BY-------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street l30 South American Street TracCalifornia Stockton, California Lodi, California Manteca, California y. ES---9-2M 10-52 Revised.W-2100