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APPLICATION FOR SANITATION PERMIT Permit NO�-V--7--------- (Complete in Duplicate) Date Issued _ ab •��- 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. JOB ADDRESS AND LOCATION___ .(-- - --/ - , '�- � -------------------------••--------------------------------------- i /Y� 11C_E-C77--------- ----------- --------------- Phone '' - f Owner's Name------------------------ Address-------------- --------------•-------Address------------------------------------------------ e- ---- -- Contractor's Name_________________________ f� Phone ��- -�?--7------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: __ -_ Number of bedrooms Y Number of baths __4__ Lot size ----____________ Water Supply: Public system g Community system ❑ Private E] Depth to Water TableQft. ,{ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,< Hardpan ❑ 1 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.) "u 1 Vnk: Distance from nearest well__________-----_Distance from foundation__________________.Material--._____________--------------------------------- WNo. of compartments-------------- -----------Size-----•--------------------------Liquid depth--------------------------Capacity_---------------------- asaI�F'�: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line______________-. t Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- E Type of filter material-__---_____________-___Depth of filter material------------ _rTotal length------------------------------------- ,_ Seep ge Pit: Distance to neares `well_-- QX-R -_-Distan d tion----- --------.Distaey o nearest lot line__...... Number of its------ , f p ---------------Lining materiaee: Diameter-------- - _ Depth----- -------------- Cesspool: Distance from riearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- F1 ______________________-_-_____---❑ Size: Diameter-------------------------------------Depth__-------------------------------------------- -----Liquid Capacity---------------------------g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ F-11 Distance to nearest lot iine------------------------------------------------------------------ ------•----------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------- --------- ---•--------------------•--------------------------------------------------------------------------------------•-------------- hereby certify th I have pr��re this application and at the�work will be done in accordance with San Joaquin County ordinancesa an rules and ulations o +he San aq ,u n_Loal Health�District. S-- --- --------------- ------- — ---C�- - [O n r andLoC +Tactor) /tel (Title} _ .__!' 2_,� �Z----------- --- ------------------------------------------ [Plat plan, 'of lot; location of system in r ation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- -_ --- DATE------- ------- ----- /' _ .r RI"VIEWED BY DATE ` - -- ------------------------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- DATE Alterations and/or recommendations:-------------------------------------------- -----------------------------------••-------------------------------------- ------------------------------------------ -------------------------------------------- -------------------- ) C.4�� ----- y------�A --- --------------------------------------- .a --- 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 8-51 Revised W-2100