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APPLICATION FOR SANITATION PERMIT Permit "'(sued,., ? __ _ ___________ r. (Complete in Duplicate) Date 1 --- - -��, 3 Application is hereby made 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 V ce No. 549. JOB ADDRESS AND LOCATION-------------Z- -�f____ ----- c „�--- - Owner's Name s- x.r- 1 Phone Phone0 ------- --------------- AddreAddress-.--------------------ffiffi---_-------------_----- ss-----------------------------------------•----- Contractor's Name----------------------------•-- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other Number of living units: ___ _ umber of bedrooms _,��Number of baths -__r__ Lot size ______ _D-'__X__../._!__S?------------- Water _ ________Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table '_. 4ft,Pe-- Character e-wCharacter of soil to a depth of 3 feet: Sand E] Gravel C❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Ic, k:� Distance from nearest well_________________Distance from foundation____.______________Material No. of compartments------------ - •-------Size-------------------------------Liquid depth-------------------------Capacity----------------------- D' sal •eld: Distance from nearest well...................Distance from foundation- to nearest lot line________________ - ..--Length of each line------------------------------Width of trench-------------------------------------- Number ypeof filter material_--_ ._._.--_________Depth of filter material-----------------------Total length___._____________________________________ See a e fit: Distance to nearest -_Distance fro foundation___ _-___.Distance to nearest lot line--_ f Number of pits---)__;.___._________Lining material__�n � Size: Diameter_____ --------Depth-----.6-O---_______________ Cesspool: Distance from nearest well________________Distance from foundation--------------."__.Lining material --------- El _____._ ❑ Size: Diameter-------'------------- ----------------Depth----------------•--•------------------ -------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest wO-------------------------------------------------Distance from nearest building---------------------------------------- ❑ Distance to nearest lot line--------------------- - .w Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------ ----- --------------------------------------------•----------- --•----------------------------------------- ----------------------•-------------------------------•-----------------•---------------------------------------------------------------------------- -------------------------•-----•-----------------------•--•----------------------------•-------------------------••---------------------------------------------------------------------------------------------••----------- ----------------------- ----------- ----- --------------------------•---- --------------------------•--------------------------••-------------------------------------------------------------------------- I hereby certify that I h ve pre `red this appligation and that the work will be done in accordance with San Joaquin County ordinances, State laws, an s an regulations of the San Joaquin Local Health District. 4 Si ned --------- nor Contractor) By:-------•------_-------------------------------------------------------------------------- l{Title)-------- -� c.Y� i (Plot plan, showing size of lot, location of system in relation to w I buildings, etc, can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y ------------- ---------------- -------------------------------- ----- DATE REVIEWED BY----------------------- ------------ DATE------ -- - --7, BUILDING PERMIT ISSUED------------------- �� ----- --------- ---••- ----------------- DATE------------------- Alterations and/or recommendations:------ - --•--------------------------------------------------------------------.---------- ----••---•-•--------- -------------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------- -------- •-•---------• ....... I ----------------------------- --------- ••-------------- ------------- ------------- ------------ 3 - ----------- FINAL INSPECTION BY:.---------_l/.-. ` !'11�.C/ L4j - Date-------- 1l._-. ---5- 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 10-52 Revised W-2100