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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) .. ___ 1 ._7.7_... + Date Issued �//A- S3 Application is here y made to the San Joaquin Local Health Di This application is made in compliance with County Ordinance NoC549r a permit to construct and install the work herein described. JOB ADDRESS AND LOCATION._p__0_/.-, _ ,_ E � -------- ----- - ----------------------- ---- Owner's Name ---------------- / ` -------- -. Phone_ _-__ O- --- -- --- ----------------- -----------------••------•-------------------------------•------------•------------- ------- Contractor's Name_______ � - •�- �- - Phone__- ___ _ __ ___ Installation will serve: Residence JK Apartment House ❑ Commercial M� O7 ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-_.- Number of bedrooms _'Y Number of baths __ -_-- Lot size -----___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ ClayLoam Clay Previous Application Made: Yes E] I No K New Construction: Yes El No ❑ p❑�'°'do�bfe�� Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: � � ✓ / �� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Z;c Tank Distance from nearest well._______________Distance from foundation--------------------Material ____-------------------------------------------- No. of compartments------------- ----- Q - _Size --------------Liquid depth---------------- -------Ca otic `''� Distance from nearest well-N.0l _�_Distance from foundation___/.: �— �___.Distance to nearestllot li e Number of lines__----- _��_.______-Length of each line------ __p_!_ _._.Width of trench.-__-e4_ ----------------- Seepage ___ __ _ Type or filter material--.1_Y,X---�-Depth of filter materia ____$ss �r -.------- Total length -Q Seepage Pit: Distance tonearest well El from foundation--------------------Distance to nearest lot line------.--------- ❑ Number off pits-__ .____ ----------Lining material---------------- ------Size: Diameter_ Cesspool: __.____._.___ ------DepA----------------------- Distance from nearest well________________Distance from foundation - ❑ Size: Diameter----- ----------------- .---_---_ ___-___-- .Lining material------------------------------------ Depth -------------Liquid Capacity----------------- gals. Privy: Distance from nearest well___________________________► ------Distance from nearest buildin ❑ Distance to nearest lot line------- --------------------------------------------------------------------------------------------------------------------------- ------------ Remodeling g -- ; ------------------------------------------ ., � - --------------------- Remodeling and/or repairing (describe)`7�}_--_�--- ------------------•• - -----------------•--- ---------------------------- -------------------------------------------------------- -------•------------------• -------- -----• ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances �{e laws, and rules and ' gulations of the San Joaquin Local Health District. (Signed)------4 By __(G4=skadLqr Contractor) :---------------- •----------••---------••----- (Title)-Fce �.rx---------- ---- - -- -- ------- (Plot plan, showing size of lot, location of system in relati n to wells, buil in s, etc., can be plonreverse side) i 9 ----------------- I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ---------------------------------- - ----------- -------------------•-•-----.----- ------- DATE---------------- REVIEWED BY -------- ............... P ------------------------------------ ------- -------------------------------- ----- DATE-----~ BUILDING PERMIT ISSUED------••---------- •---------------------•-------------------------------------------------- Alterations and/or recommendations--------__-___.____-------- DATE-------- ----------- FINAL INSPECTION BY:-------------------- �/� f/1k ------- Date----- � / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street' Stockton, California L 814 North "C" Street Lodi, California Manteca, California Tracy, California E5-9•--2M 10-52 Revised W-2100