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T APPLICATION FOR SANITATION PP / s RMIT Permit No. .�� 6 �� (Complete in Duplicate) Applica ion is hereby made to the San Joa Joaquin Local Date Issued This application is made in compliance withCountyOrdenat cbINoC549r a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION..._ ____�j_ __._- _--- ---- Address__________________• Phone__-5 ,_•-- -- Contractor's Name._. ------------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motels❑ Other ❑ Number of living units: _l Number of bedrooms _ •2 Number of baths __ -- Lot size __-____ X0: i Water Supply: Publics stem - �O Y � Community system �' -----•-------------- ------ ------ Y Y ❑ Pr.ivate ❑ Depth to Water Table.,?M- ft- Character of soil to a depth of 3 feet: Sand - ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ -Clay ❑ Adobe ' Previous Application Made: Yes No Hardpan ❑ ❑ New Construction: "Yes ❑ Nobz, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-________________Distance from epos ,fie`ld�/: foundationNo. of compartments------------ SMaterial ize-----•----- -------------- Liquid depth--------- CDistance from nearest well-------------- Distance from foundationDcapacity-------_-_-_----- Number of lines----------------- ___________ ste to nearest lot line -------------Length of each line---------------- o ---------.Width of trench --------------- � Type of filter material----------------------- -Depth of filter material____.--_--__-.-.-----.Total length-------------------------- ------ --•----- / r; Seepage Pit: Distance to nearest well -�f Distance from foundation____®--_-•,Distance to nearest lot line-------------------- Number of pits.._.____-----------Lining material-- -.Size: Diameter-----'3-4----------Depth-----�-.1 Cesspool: Distance from nearest well-----------------Distance from foundation-____._- -------------- --- � r , F Size: Diameter--- ------„.-- -----Linin material--------:--- . ----Depth � ---............... Privy: Distance from nearest well------------------ ............... iquid ..Capacity--------- _.__ al _____________Distance from nearest buildin gal Distance to nearest lot line------------- ----- b0ding-------------- Distance --------------------------- emodeling and/or repairing (describe):---------- ___ ---------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count { tate laws, and rules and regulations of the San Joaquin Local Health District. q Y ordinances. S �. (Signed)--------------- ----------- ------- By: ----- �/)-_�_Iner d/or Contractor) + Y i g (Title) (Plot plan, showing size of lot, location o stem in relation to welts buildings, etc., can be placed on reverse side).------------------------ ----------------------- } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _______________ _ --------------------------------------- REVIEWED BY--------- --------------•--•---- ------- - �- - DATE------ -- ---�----- - -- - ----------------- - tJILD1NG PERMIT ISSl1ED---------------------------- � ---- �------ ----- ------ - DATE------------------------------------ ----------------- ------------ ----------- A terations and/or recommendations------------- ------------- ----------------- -- ------------------ --- DATE------ -------------- ------------------- ------------------------------- •-----------------•-•-------------------------•-------•--• ------------ ------------ ------------•-------- --•--------------------------------------------•----•----- --- ------------- _ FINAL INSPECTION ' k �--- ------------ bate ----- .. ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street Stockton, California 132 Sycamore Street 814 North "C” Street Lodi, California Manteca, California - Tracy, California I ES-9-2M 10.52 Revised W-2100