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�5 A PLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued 1 UU VfApplicafion 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 wifh County Ordinan 21 No. 49. t E �2. F: JOFfiADtiRESS AND CATION uof Owner's Name- _ = Phone Address------ -s-•---- • --- - - ----------------- - -- ------------------------------------• ----------------------- --_------•--------------- Contractor's Name---------- --------- ----------- ---- -----------=- ------------------------------------------------------------ Phones, Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: _/---- Number of bedrooms 62,_ Number of baths _ _ Lot size ------/I-PZ __j1r_ Water Supply: Public system ❑ .Community system ❑ Private��1W Depth to Water Tableoz,�ff: Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy aaLoam ❑ Clay Loam ❑ Clay 0 Adoba-EV Hardpan.❑ Previous Application Made: Yes ❑ NcNew Construction: Yes '°No E]TYPE,OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well -----Distance from foun dation//l-----------M, -__---- N No. of compartments__------------------Size_ _ _ _________Liquid depth, ___ a, -_,___Capacity_____ . Disposal Field: Distance from nearest well-_,0-_*_-Distance from foundation/ ---- Di to nearest lot Iline----�_----_ ti Number of Eines--------/I---------------- Length of each line-----�-E -_-�--------Width of french-----„2--_�------------------ Type of,filter maferial_rJ"��- Depth of filter material-/--- ------------Total length--------�Q---------------------- See ___-_--__-_-__--- p e ' / 1 / See a` Pit: Distance to nearest well-/", -___Disfance f m fo dation_/�---_-___.Distance to nearest lot line-�_�!- -. Number of pits----- --------------Lining materia Size: Diameter-_ /1-_ Dept h-------- Q Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material-_____---___-____--_-_------___-___--. I ❑. Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------- gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------.____---___----__. ❑ Distance to nearest lot line ----------------------------------•---_---------------------------••---•------------------------------------------------------- Remodeling 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 County ordinances, Sta flaws, and es regulations of the San Joaquin Local Health District. (S, ned -9 ) (Owner and/or C rector) ;BY: F +� ------------------------------------------------------------------------------------- ----(Title)-- --- -- - (Plot plan, showin ize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED 'BY----------- -----------------•--------- - - -------------------------------------------- DATE----- REVIEWEDBY -------------------------------------------------------•------------------------------------------------------------- DATE------ =----------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------------- - DATE Alterationsand/or recommendafions:---------------------------------------------- ------------------------------------------------•-----•-----------------------•----------•------- ' ----- ------------=-- - --------•--- ------------------------------------------ FINAL INSPECTION BY ... . . ...�, ::... ----------------------------------------- D .� ate-------- - - -----------------------•--- ---------------- r l 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 E5-9-2M 8-51 Revised W-2)00