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APPLICATION FOR SANITATION PERMIT Permit ,✓ f1 (Complete in Duplicate) lute Issued Af*.plication is hereby made to the San Joaquin Local Health District for a permit to con truct and ' tall the work herein described This application is made in compliance with County Ordinance No 549. JOB ADDRESS AND LOCATION___ �a�- +�_ ` ____ -- _ ,� ``' 'd- -,�11 tr��' _ ,r9 c -------------------------- -- ,j!— Owner's Name------------------•--------- � �- Phone Address--------------------...................•-•-•----- ..9-------� ------ ------------------------------- - Contractor's Name-------------------- l.+d�l�_$_. r "` Phone_ Installation will serve: ResidencApartment House [ICommercial F1Trailer Court ❑ Motel ❑ Of er ElNumber of living units:---f- Number of bedrooms __ Number of baths j____ Lot size - .�" Water Supply- Publics stem El system ❑ Privafe pepth 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 ❑ No0__New Construction: Y&4,0 ar Noo- TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �► 5 tic Tank: ` Distance from nearest well-----------------Distance from foundation--------------------Material__._--._---.__-.______._-_-____________________. ✓' No. of compartments--- ;e ----_--Size--------------------------------Liquid de�h�------------------------Ca Capacity p tY -Disposal Field: Distance from nearest wllr II___ Distance from foundatinL_ Distance to nearest lot line_____ Number of lines------------- -------- ----________Depth of filter material______-----Length of each line--- --U_`---------,___.Width of french_.r�_ ______- Type of filter material__ j�=f_____ -/ let Type length-----c9_Q-------------------------- ------------- ________________--_____ Seepa e Pit: Distance to nearest well_/49® ____-_Distant fo ndation__,�+�_r__Dista`ce to nearest lot line----/Q_�__ l�•�'E -c�'_Size: Diameter Number of pits------------ ------Lining material-__ -- -- __-- _ - -Depth-----1-__C----------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.___-____________________- + ❑ 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----- o------------------ --------=-- - - ` --------------------------- R AAA Z � .� ---------------------------------------------------------------------------------=-----------•-- -------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couniy� ordinances, State laws, aH rules and regulations of the2S n Joaquin Local Health District. 5i ned_____ '' -----------------------------------------------=-------------- Contractor i' x - ----------------------------------------------------------------------- (Title]_ .C�� r . -t1------------------------- - SY� �`.., �,- (Plot plan,�sho ng size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY r + APPLICATION ACCEPTED BY------•------ -- - - -------------------------------------------- DATE---------- --- -' ------- REVIEWEDBY--------------------------------------------- ------------"------------------------------------------------------------------- DATE------- ------------------- -----------------•------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------- ------- DATE------------------------------------- _ Alterationsand/or recommendations:-----------;----- --"------------------•----------•-----------------------------------------------------------------------------------------------------= ------------------------------- -----------------------------------=-----'•------------ ----------------------------------------------------- ---------------•-----------------------•-------------------------------------- ------------------`---- ry----------------------------------------------------------- --------------------- r , _____________________________________.____-________-____.______.---_-_--_.___.______________________._------.---_____-_______________.---.-----.-___.__.__-__--_________._-----_-._--_---.---______-"______________.___-_ FINAL INSPECTION BY:------WV__/i--- -------------------------- Date--------- --------`�j-------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North r'Crr Street ; Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100