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APPLICATION FOR SANITATION PERMIT Permit No. .fC�. �.. "I Z (Complete in Duplicate) jq Date Issued ................. Application is hereby made to the San Joaquin Local Health,District for a per 't to nstruct and inst l the work he n d scribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATION--.. tSJ .t,-•- ��(J. -- --- --------- -----•- --..._... Owner's Na .............. - - ----- - ----- -(---- ----- ------• ----- Phone Address - - ` ... .._..rt.... o� -. .. 01 Contractor's Name. i - a:. . •--- Phone Z _0 . ,� ^0 Installation will serve: Residence g Apartment House ❑ Commercial Q Trailer Court ❑ Motel 0 Other ❑ 2�_ Number of living _ -- units: _. _.__ Number of bedrooms __. Number of baths -./ Lot size ._ Water Supply: Public system ❑ Community system)'g,_Private ❑ Depth to Water Table........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay�Adobe4 Hardpan El Previous Application Made: Yes E] No�--Alaw-Construction: Ye�No ElFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank cr'casspool permitted if wblic sewer is available within 200 feet.) r Ar . Septic Tank: Distance from nearest w IIQ Distance from fo ndation__- Q ____..Mate ' I 1C-- s ---L� �-- ---Ca acit No. of compartments--- _ _ _ ___Size__ ._ _ ..___ quid dept __-__.__ p _01 Dispo al Fie Distance from neAca&*-v/ell-1-0.0-1-...D?ance from fot padafion Distance to nearest lot Ii __ _Z� Q Number of lines .-------Length of each linemr ...Width of trench. �..:... ., ;r J Type of filter ma erial -----------------Depth of filter material-----------------------Total length.... Seepage Pit: Distance to nearest well---------------- ____Distance from foundation....................Distance to nearest lot line.-`._... ❑ Number of pits----------_---- Lining material._--------------------Size: Diameter------ --------------Depth--....... .--. Cesspool: Distance from nearest well-- _______ Distance from foundation _ -----Lining material.......... .:........•--•-,.. El Size: Diameter------ - -------Depth---- ----- - - •-----.._Liquid Capacity ---- 9 Is�� Privy: Distance from nearest well____________ _ __:___ '_____ ___.__-_--.Distance 'from nearest building'.-__ ......... ❑ Distance to nearest lot lin --- -- -•- ------ -----•- - ---. ---- Remodeling and/or repairing {describe):._ ----- ------ - -�+ '- ---- --- . .__ ......................... -- -- --- ---------------------- ----- -------- -------- -------- ------- ------- - ----------------------------- -•----.------------ ----........................................---- I hereby certify that I have prepared this application rl nd tht the work will be done in accordance with San Joaquin County ordinances, State s, and rules nd regulations of the Sn Local Health District. - SAY�NIGHT _ Contractor S is Tank_Sstrvic�a ----. . *'.... , . .. ) 6 HO 2 TWi (rte) By:----------- ... - ---, ...(Plot plan, showing size of lot, locatiofsystem in.relatio buildin s, etc., can be placed on reverse side). FOR DE RTMENT USE ONLY APPLICATION ACCEPTED BY----- IF---------- -- ••-• -- ......... .......••-•-•-•--- DATE_.'•.�!..`..� ---- ......--.....----• REVIEWED BY- DATE '_ BUILDING PERMIT ISSUED... ............... :..... ..... -- ---. •----_• . --------. DATE..-•-- -- . --_ ----- ... . ........... Alterations and/or recommendations-..---_- -------_ -----------------------------------------------------...--. ..........:...... .. ............................................ a, Iwo 6 FINAL INSPECTION BY: .... Date ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M , Revised 1.57 F,P.CO.