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i? / �-r'�..'.w�T'"r.�-'°r.•_'°*`�,^,.--�--r-�»-...rte.-��.,_s ' APPLICATION FOR SANITATION PERMIT Permit No. .__-_ (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct a This application is made in compliance with County Ordinance N 49. nd efall Ze work herein described. JOB ADDRESS AND L ------ C /,� �j �---- -` ------ - a----- -• c�n�e-12�--C 1 Owner's Name-------- -----------------------------------Q- � = - A a Address Phone 7a / Contractor's Name 5 - Installation will serve: Residence Phone__ __ _-_- d ----- ---------- Installation House [] Commercial ❑ Trailer Court ❑ Motel p Other ❑ Number of living units: _--� Number of bedrooms _2� 1 --- Number of baths -__/-__ Lot size _-_---___________________ ____________________ Water Supply: Public system 'Community system ------------ X Y ❑ Private ❑ Depth to Water Tabl •ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Previous Application Made: Yes N ❑ Ad°beg Hardpan ❑ o,� New Construction: Yes El No ❑ � `s�,jT TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Distance from nearest well_____.----__ tic Ta : �„r Distance from foundation-------------------Material_--_--- ____ No. of compartments------------- ---- -------------------- Size -----"--------�----Liquid depth------;---- i Capacity • ------------- -- Disposal Field: Distance from nearest well--mss* .-.Distance from foundation-t-Q._'_-------Distance to nearest lot line------Number of lines__----1__---_ __-- ---------_-Len th"of each line__- __ '� •--- g --" Width of trench '-' Type of filter material__1j�!! ,`-_---Depth o{ filter material--__/� " ' - ----:---- ---Total length-__�'p-�-------------------•------•- Seepage Pit: Distance to nearest well_-��e+..�--------Distance.from-foundation--:� Nu' ber of pits.__ �=�='.-_..Distance to nearest lot line_-.---- r a �- - --.._-___Lining material_ .. - Size: Diameter._--__ Cess ool: ,3 ; Depth---r2-[?_ • A2- Cesspool: Distance from nearest well---------------- Distance from foundat•ion-----._--_-_----- Lining material Size: Diameter------- -- Depth - ---------------- --•-----Liquid. Capacity----------------- ------ l Privy: Distance from nearest well- ------------------ - gals. -- �----_Distance from nearest buildin ❑ Distance to nearest lot line ---------- 9 Remo elinq and/or repairing (describe):__ _ F = -------- -- `. --- - -- .. t - ------------ - ---- ------------------------ -- ---- --- -- ----- I hereb certify that I have prepared this application and that the wo'k will-be done in accordance with San Joaquin County --------------------------------------- ------------------•-------- or inan 5, State ' and-rules an regula ns of the San Joaquin Loc Health District. (Signed) } ------------------------------ - ---- t �.. ------ --- By:----------- ••• r-�Contract ------- or) (Plot plan, showing size of lot, location of system in r ion to bui m s, etc, can(rtle _�?`k• --_ 9 � be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---- --- - ----- ! REVIEWED BY ' ••_: T -- DATE----------- - --------- BUILDING PERMIT ISSUED------------- DATE......° Alteration and/or recommend ti ns:- - -• -------------- ----- -- DATE- :.ii ---° t , ---- ------ ------ --- ------ �, �� - 3 ,� -- aIA- � f -- -- ---- -- - - --- ----------------------------------------- FINAL INSPECTION BY-------------- tU .. -� 5�� -------------------- - f��'"� - --- • --------------- Date----. JOAQUIN LOCAL HEALTH DISTRICT i30 South American Street +300 West Oak Street 132 Sycamore Street 814 North "C" $} Stockton, California Lodi, California teat Manteca, California Tracy, California ES-9-2M : Revised W-2100