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APPLICATION FOR SANITATION PERMIT Pej�mit No, (Complete in Duplicate) Date Issued 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 Ordinance No.-549, 0-?0—(b L(92-1 E. D JOB ADDRESS AND LOCATION-4- Owner's OCATION- ----Owner's Name-------------------- ,--- *-�• 6> PhOne -'`�"` Address -- ---------------- ----------------------------------------------------- Contractor's Name __ -4-r------------------------------------------------------------ - ----------------- Phone.... - -- -� - - Installation will serve: Residence (M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J____ Number of bedrooms _ Number of baths .1___ Lot size --- ------A-___7__.f---.----------------------- Water Supply: Public system ❑ Community system ❑ Private K Depth to Water Tabletz9l0 ft. l��••p.1 K Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam J� Clay ❑ Adobe❑ Hardpans' Previous Application Made: Yes ❑ No 9- New Construction: Yes j- No ❑ 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_.E�_0'�__Distance from foundation 0 MateriaL__� --------- _ N No. of compartments-,.-�..__..____--__Size_a' ____ _�, Q�__p-_-----Liquid depth__.jX12._"-----------Capacity_POLO -tom, Disposal Field: Distance from nearest well_-f_C>_.__._DistakArom toLthdation_a-0Q__.__.._.Distance to nearest lot line___ [ Number of lines----1----- }/ -- ____--Length of each line----s��------f f---.Width of french-- T rench- ��"------------------ Type of filter material___/y_ _Depth of filter material________, ______.Total length_aR_0-_ ___________________________ Seepage Pit: Distance to nearest well-./- _E?' ____Distance frorn foundation__s-___ __.Distance to nearest lot line_-Z ---______ Number of pits------I Lining material___ Size: Diameter__ __-_ _ Cesspool. Distance from nearest well-----------------Distance from foundation--------------------Lining material___.__________._________-.--_______ ❑ Size: Diameter--------------------------------------Death_---------------------------------------------------Liquid Capacity-.------------------- -----gals. Privy: Distance from nearest well __________--------------------------------------Distance from nearest building------------------------------ --------._. ❑ Distance to nearest lot line Remodelingand/or repairing (describe):--------- ----------- --------------------------------------------------- -••---------------•-- -------------•------------------------------------•-•-- ------------•-•------------------------------------- ------------•------------------------------------•------------•------------------------------------•--•------•---------------------•------------------------ ---- I herebPa tify {hat I have prepared This application and that the work will be done in accordance with San Joaquin County ordinances, laws, and ru s and regulations of the San Joaquin Local Health District. (Signed)------- u1,iGt!1� ------- Contractor) By:---------------------------------------:- --- (Title)- ------------------- (Plot == (Plot plan, showing size of lot, location of system relation to wells, b ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By - - E DAT ; REVIEWED BY------------------------------ - ��-- --------------------------------- ----- .-. DATE BUILDING PERMIT ISSUED------------ --------------•----------------------------------•------------------•----•--------------- DATE----- ._fig.. Alterations and/or recommendations:-------------------------- ---------- -----------------------------•------------------------------ ----------------•------------•--------------------•---------------------------------------------------------------------------------------•------------------------ -----------------••----------------------------------- ----------L--- -------------------------------------•---------------- - ------------------------------- ------------------------------ •----------------------------------------- ---------------------------------------- •---------------------•----•---------------------------•--------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------- --------------------•------•-------------------•-----------------------•-- -------------------------- ------------•------------- --------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.. ____ Date°- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 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