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APPLICATION FOR SANITATION PERMIT Permit No. _--_ ' ._ (Complete in Duplicate) Date Issued ._,� Ilcation is hereby ! pP y made to the San Joaquin Local Health District for a permit to construct and install the work herein de ribed. This application is made in compliance with County rdinance No. 549 JOB ADDRESS AND LOCATI 1 ----•- -------- r�rOwner's Name---------------- -- -- -----•-- -- ----- r - -- ----- -- Address9Phone .. ---Z�.... ' -- -•-- I.� = ----•---------- Contractor's Name-------- __ tM1-��--o. --- -- (:—? --------------- Phone_�-7h�d? Installation will serve: Residence Apartment House ❑ Commercial Trailer'Court ❑ ❑ Motel Other ❑ Number of living units: �_�_ Number of bedrooms Number of baths ----�_ Lot size F.._ .. ~ • --------------- Water Supply: 'Public isystem ,[Communify system ❑ Private ❑' Depth to Water Table Character of soil to a depth of 3 feet: " Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ N90 . New Construction. Yes No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well_- !e _'Distanc ..from foundation_--_-�y Material_ --------- ------- p No. of compartments---------a2 .---------,$izerO`-�Q_ �-`_--Liquid depth_.-. ECapatitY---/-d0--. / t p� I " F Disposal. Field: .Distance from nearest AS----- Distance from faGndation:_- r - } -___-.-Distance to nearest lot li ne-_---_f N`mbar of.'lines-----------------„ Length of each line------:'--- - _ gtl�^ ✓� Width of trench-----[ ---- -------- Type os filter mate�ial� �___ _____________De th of filter material_----- -___ --- len th___-_ _0�-_1-___--_-_-______--____._ kA Seep -Pit: Distance to.nearest weii_._ - /-- _____Distance fro four ation__:., �-_,..._-.Distant I to nearest lot lines_ material_ : ``3 rs �:. - - g ..... -Size:�Diarneter_.--.,�-��-:_._.De th--- '.Distance of pits --- -..----_Linin p. r�---------- -------------- Cess❑pool: SDizea Diameter nearest well-----------------°__ _ Distance from foundation__-<_._-__�''-.._Lining material-_ Depth ------------------------------------ r----Liquid Capacity---------------------------gals. Privy:_ Distance from nearest well__".____--_._____'-,_-____" " _______Distance from nearest building------------------------------------------ + „. ❑' Distance—to—nearest' line 411- ----'------------------------------------------------------------- Remodeling and/or repairing (describe)_________________________________ -----------------•------------------------------------------ I + i ------------------------------ - :•• - ------------ ----------------------------------------------•------ --------- I,hereby certify that I have prepared this application and-that the work will be done in accordance with San Joaquin County ordinances, State I and'rules and regulations of the San Joaquin Local Health District. -t (Signed)------------- -= t••�, By:. rContractor) r and/o - (-Title)-- ___ (Plot plan, showing size of Iot,'location of.system in relation-to wells, buildings, etc.,.can be placed on reverse side). " FOR DEPARTMENT USE ONLY . . :.. APPLICATION ACCEPTED B _- ----- -------------------------- DATFI---- ---•--------- --------------------------------- REVIEWED BY- --- ------------- -_ ------------ DATE.... .� BUILDING-PERMIT ISSUED-------------- ---- - _.:.., ------- --------------------- DATE--------9.` � ---------------------------- Alterations and/or recommendafions:__.__,.-__-__. = t ------------------------------ ________________-----------------------__________________________________�____ Y ' _______________ .____•...__-_-______ 4 -----------------------._--.---.._._.-_----___.--- _____..- ; -----------------_----------------------------------------------------__-- _.-_--_--__ •---__-_-___--_--_------ 4 --------------------------- ---------------------"-------__ • .. FINAL 'INSPECTION BY------------------ ' `- � ------. ( V `f Date IT-- ------------ ---•------------- --------- SANJOAQUIN LOCALNHEALTH DISTRICT 130 South American Street 300 West Oats Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M I0-52 Revised W-2100