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t1� APPLICATION FOR SANITATION PERMIT Permit No. ----__ _________ \0 (Complete in Duplicate) Date Issued/__0_ 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION-.J.1111--ii--on ----------------------- •- •------------------------------------------------------ --- - -------------------- Owner's Name---------------------------------- --- - - - ------------------------------------ Phone----�=-"�nl�;--� Address.............................................. am - Contractor's Name-------••-•---------------- -------------------------------------------------------------------- Phone----9': -_Q_7-------- Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ rr w Number of living units: /- _L ____ Number of bedrooms .L_____ Number of baths ----- Lot size ___________________ Water Supply: Public system Community system El El Depth to Water TableWX ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 19 Hardpan ❑ t Previous A,pplication. Made: Yes ❑ 1 No W New Construction: Yes ❑ No ❑ (9,�rj0L ,- TYPE'OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .t Se tick pk: Distance from nearest well-________________Distance from foundation--------------------Material _____--_________-________________----__--__-__{ Noof compartments------------- ----------Size--------------------------------Liquid depth--------------------------Capacity-----------------------� Di osa field: Distance from nearest well-------------_-_Distance from foundation-------------------.Distance to nearest lot line_______-___-_____ Number o-i lines-=---------------------- --------Length of each line--------------------- --------Width of trench-----------------------------------` . Type of filter material---------------_-______Depth of filter material---.-------.__-_____--Total length------------------------------------------ Seepage Pif: Distance to neare t well_.0-OnF-_____Distance fr m foundation_.•_-----.Distance to nearest lot line -_, Number of pits--- - ---------------Lining material_ .--Size: Diameter----- oV!------Depth--- ►--`s]--- ---•---------- 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_---------------______________-_._.__.--_- 1 ❑ Distance to nearest lot line__________________________________________ 1 , t Remodeling and/or repairing (describe)----------------------- --------------------------•---------------------------------------------- ------------------------------ ------------•••------------•-••-------------------------------•-------------------------------------------------------•-•------------•------------------ F E I hereby certif t 1 have prepared this application and that the w irk will be done in accordance with San Joaquin County ordinances, State aws, nd rules an reguia ' its of the San Joaquin Loci Health District. (Signed)--------•----- — ------- ---- ---- - - -----..----- ---- � Contractor BY° `---•- -------------- (Title) � `� � (Plot plan, showing size of lot, location o st in lation to wells7bd�ings, etc., can be placed on reverse side). r ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------ -•------------------ DATE// REVIEWED BY DATE --------- -------------- --- BUILDING' ------------ --- BUILDING' PERMIT ISSUED------------ ` — ----------------------------------- DATE-------------------------•---------------------------------- Alterationsand/or recommendations:----------------------------------------------------------- ----------------------------------- ------------•--•---•------------------------------------------- -------------------•------------------------------------•---;-------------•----------------------------------------------•--------------- --------------------------------------•-------------•---•---•-------•-- -----------------------------•-------------------------------------------•-------------------- ----------------------------------------------------- FINAL INSPECTION BY------- ------------------------------------------- ------ Date i ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9--2M 10-52 Revised W-2100 " �