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APPLICATION FOR SANITATION PERMIT Permit No, f' (Complete in Duplicate) _ i Date Issued 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 i�h County Ordinance No. 549. JOB ADDRESS AND LOCATION_ _----.__ (j/ `f � r -... Al -------- 15. - ---• _ - 1-- .- _- . ��--j-----l� �.------�------------- ----------------------------------------- ------- Phone Owner's Name Address------------ -- •`------------------- ontractor's Name -------- . -- ------ --- - -------- e---- - -- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __,m--_,Number of bedrooms _-_ Number of baths __- Lot size ---------------- I Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �6 ft.P., i Character of soil to a depth of 3 feet: Sand ❑ GravelSLoam ❑ and y ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes E] No [ ( New Construction: Yes ElNo x TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) { i Septic Tank: Distance from nearest well-----------------Distance from :foundation--------------------Material___-------___--- ___--- ❑ No. of compartments--------------------------Size-.-----------------------------.Liquid depth--------------------------CapadtY Disposal Field: Distance from nearest well---, _ _ -_-_.Distance from foundati n._ t.--_-_____-Distance to nearest l ~' ot Number of lines.t-,O-C�& }___----------Length of each line---- ............. -Width of trench-- ------- ,,e�,,'��_r� Type of filter material ----ROOK-Depth of filter material_--- __________-Total length--__(�?f1 -_•----_-__ Seepage Pit: Distance to nearest well----,pDistance from foundation-_ ' -------- to nearest lot line-�______-- Number of pits--,01i(e--------Lining material__0/�'_f 0f C---Size: Diameter-. �_�� - / ---- Depth-,54------------------ Cesspool: Distance from .nearest well-----------------Distance from foundation__________________-Lining material-----__---___--_--_--_____-.------- ----------------------- - ---. ❑ Size: Diameter =------------Depth----------------------------------------------------Liquid Capacity. --- aIS. Priv ' g Y, Distance from nearest well_----- _--- Distance from nearest building ❑ Distance to nearest lot line_________ , - ------------------------------------- Remodeling and/or repairing ( scribe _-_-.- -----fir :. ----------•------------------ •-4------ � �� -'� - -------• - - ----- ------------------------------------- t Ihereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County ordinances, tate laws, and rule _- regulations of the San Joaquin Local Health District. (Signe - c--1-d--�' -° I-- - C . P1. xm-------------------------(Owns and/or Contractor)BY: --------- ----C Ems.------- ----------------------------------(Title)------ {Plot plan, showing s e of lot, loof system in relation to wells, buildings, ef�c., can be placau on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----_-__--"- - ---- •.�-- ,r" _ DATE ------ WED BY �` ! --------------------------------------- BUILDING -- DATE-� PERMIT 155UED---------- ---------------------------- - -- ---------- �� Alterations and/or recommendations:-----___ ' DATE--------------------- ----------------------- --------------------- I --- - ------------------------------ - ------------------------------ - -------------------------------------- - - -------------------------------------------------------- FINAL INSPECTION BY----- --- VWL- - --- --------------------------- ------------- Date----- ..- -_-- - -- `I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 60 West Oak Street 132 Sycamore Street 814 North 'C" Street Stockton. California nia i Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100