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li II APPLICATION FOR SANITATION PERMIT Permit No. ----------�W.. (Complete in Duplicate) Date,lssued .4 Applica-1-ion 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. JOB ADDRESS AND LOCATIO --- -- ------------- . ..........j ----------- Owner's Name- ..... . - I ------- one----------------------------------- d—d r- _; *;-M i!, A - ------- ------------------ ---—------------ ---------------------------- P, ------------------------------------------------------..---------------------------:---------- Contractor's Name. -------------------------------------------------------- -------------------------------- ---------------- Phone------------------------------------ Installation will serve: ResiiZi'lce --Apartment House E] -Commercial [] Trailer Court [] Motel E] Othe", E] Number of living Number of bedrooms ---(-- Number of baths ---f_-_ Lot size -- ---;9 --------------------------- Wafer Supply. Public system Community.system E3. Private Fj Depth to Water Table -------- ft. - Character of soil to a depth of 3 feet: Sand,E] Gravel E] Sandy Loam E] : Clay Loam E] Clay E] Adobe Hardpan ❑ Previous Application Made: Yes No K New Construction: Yes No 4 A ❑ TYPE OF*INSTALLATION AND SPECIFICATIONS: (No sepf te tank'or cess�'oof permitted if public sewer is available within 200 feet,) P Septic Tank: rom nearest e '__Disfa_ncje from foundation:---- K1_ __.I Distance f` w f ,Mater -----------a4___ No. of cor�parfmenfs------;--—-------- _-Si,e--- ----Liquid depth_______------__-_- Capacity__ Field: Distance from nearest well----f_=L----Distance from foundation-----/_-4�------Distance to nearest lot Number of;lines--------- -Length of each line---------6-0. Width of french or -------- --- 7j?-A----- -- ------------------- Type T .0- ---------------------- filter material--ZF ----Depth of filter material----J-- --------Total length---, Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- Number of pits- ------Lining material_---_----- --------Size: Diameter------------------------Depth--------------------------------- r Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-------------------------------------- Size: Diameter- ----------------'' -- --------------------Depth - ------------------------------------------------ Cae ---------------------9 s. al Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---!----------------I--------------------- Fj: Distance to nearest lot line___ -- ----------------------------------------------- ------------------------------------------------------------------- Remodeling and/or epafring [desyibe):----- ------- ------ -- --- - ---- 'opreparedc --- ------------- ....... .A - T --- - --------------------------------------------------- ------------------ ------------ ---- --------------------------------------------- ------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------- I this application and that the work will be donia in accordance with San Joaquin County- I hereby certify fh,� I ordinances, State laws, and rules and egplafions of the San Joaquin Local Hea-If6gis is -------- qU (Signed)! (Owner and/or Contra ---- - ctor) 'By:----------------------- -------------------- --------------------------------------------------------------(Title)--------------------------------------------------------------- -ZW erse 51 e Le (Pl6t'-pl Wo-;ing size I i relafior�to wells, buildings, e+c., can be`p a c;7n r�v an, s of W"oci;fio.� f system in FOR DEPARTMENT USE ONLY ............. .. APPLICATION ACCEPTED BY ................-------------------------- DATE------ ----•---------`---------- REVIEWED BY---------------------------11----------- ------------- _ -------------------------.-..' DATE- -------------- BUILDING PERMIT ISSUED----IP------------------- ----------------------------------------- DATE —---- - ----------------- ------------ .Alterations and/or recommendations:------------------- ------------ --------------------------�---------------------------- ----------------------I i---------------------------- - --------------------------------------I------------------------------------------------------------------------------------------------------------------:------------------------------------ ---------------------------------------------------------------------------------- -------------- --------- ---------- - ------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- --------------------------------=- ----------------------------------------------------------------------------------------------------- --------- II ------------------------- ------------------------- ------------- ---- ------------------------------------------------------ ---------------- - --------- --------------------- i------------------------------------- FINAL INSPECTION BY;....- ---- ---- -- - ----- Date--------------/ ---------------------------------- 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 Revised W-2100j