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b APPLICATION FOR SANITATION PERMIT Permit No. _ ........ 1�} (Complete in Duplicate) Date issued -0-' -- 3 Applica4ion is hereby made to the San Joaquin Local Health Di ict for a permit to construct and install the work herein described. This application is made.in compliance with County Ordinan o. 5 99 �,L ;I -JOBADDRESS ON..--,cam `L CJ --------- �� ----2- �� ' -------- ,v Owner's Name----------- -- -4067 I----1-4----zi-. -- ..... -`-------------- = ------ Phon Address---------------------------------------------- - ��o------------------- Contractor's Name-----------------------------------I-----��''_�'°_f..��-------��------------------------•--------------- ----------- Phon Installation will serve: Residence Apartment House ❑ Commercial ❑ Trajler Court ❑ Mote! ❑ Other ❑ 1 Number of living units: _______ Number of bedrooms __�__ Number of baths __ __ Lot size ___ r_---------- ---.- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 1477ft, Character of soil to a depth of 3 feet: SMand . Gravel El Sandy Loam El Clay Loam n Clay 0 Adobe�lardpan El Previous Application ade: Yes ❑ No ew Construction: Yes'❑. No ❑_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se is T Distance from nearest well__________ Distance from foundation--------------------Material-----------------------------------------.------- No. of compartments----- ---------- � n Size-------------------------------'Liquid ae th-------------------------- Capacity----------------------- lot line____________ biosal F' Distance from nearest well-________________Distance from foundation---------------.....Distance to nearest -____ ` �► Number or lines -----------Length of each line------------------------------ of trench----------------------------------- Type of filter material______________---------Depth of filter material________._ ---------Total length__--___-______________--_---------------•- ff S�yys� Q__.__.Di tante to nearest lot line____�D__� Seep a Pit: Distance to nearesfft well__1__x�t/- _Distant f foun anon___._ Number of Fits_____i-----------------Lining material, _�� ize: Diameter__-13...-----Depth__!- �-- Cesspool: Distance from nearest well______________ __Distance from foundation__._-.____�__--- Lining material ____._.,_.---_____________________-. Size: Diameter-------------------------- -----------Depth---------------------------------- ------ ---- nearest Capacity gals. * Privy: `Distance from nearest well--------------------------------- --------------Distance from nearest building----------------------------------------- ❑ ------------------ •-=--------------- ------------------------------------------------------ Distance to nearest lot line----------------------------------------------- - .. Remodeling and/or repairing (describe):----------------------------------------------------------- ------------------•-------••--------•---------------------------------------------------------- : --------•-------------------------------------- ________ _ --•--------------- --------------------------- -----------------------------------------------------••--------•----------------------- hav - p d - � I he certify the I have p pared t i applicati n and that the work will be done in accordance with San Joaquin County ordinances,`Sta law nd r es d re ul ns of A n Joa in oca ea lth District. (Signed) - ------- --- - actor) -- --- ------- :. .er*? ---------------- -- By------------------•-----_-------•-------------•-------------------- { Tale (Piot plan, showing size of lot, location of system in el ion to wells, buildings, tc., can be aced on reverse side]. + FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY;--------------------- ------------------------------° YG DATE --/—_4--= �� 1 REVIEWEDBY----------------------------------------------------------------------------------- ------------- DATE----------- ------------------------- BUILDING PERMIT ISSUED---------I------------------- --- ----- DATE . Alterations and/or recommendations---------------------- --------------------------------L........................... -------------------------------------------------------------•--•------------ -------------- ---------------•--•---------------- --------------------------------------------------- ----•-----•------------ ------------- 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 : Revised W-2100