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APPLICATION FOR SANITATION PERMIT Permit No. X7 7e9 (Complete in Duplicate) I/ Date Issued __- Applica¢ion is hereby made to the San Joaquin Local Health Dist ricf for a permit to constr This application is made in compliance with Count Ouct and install the work herein described. rdinance o. 549. JOB ADDRESS AND LOCATION--_-_(.""_L. _ _ --------- -- - -------- ---------- Owner's Name."" � 4 --- :. Phone Address...... ------------------ --- --- !- - - Contractor's Name-------- __•_ -. --------------------------------------------❑ • - - - ---•--------•-- Phone.."".--••-----------------�-' _=� ---------------------- -- Installation will serve: Residence Apartment House Commercial ±` ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms Number of baths F ----- Lot size .1"-�"L i ----------------------------- 0Water Supply: Public systemy ❑ Community system Privat Depth to Water Table"-___'" ft. Character of soil to a depth of 3 feet: Sand [l Gravel ❑ Sandy Loam ❑ Clay.Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ `� Previous Application Made: Yes E❑ No New Construction. Ye SV No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ° (No septic tank or cesspool permitted if public sewer is available within 200 feet,) Septic Tank: Distance from nearest well: _------Distance from foundation---�-�Q .-"".Material.__ -_. X\ INo, of corn pa rtmenfs_.__Z - ,`� + Size-_ �E6'",4( Liquid depth_ Capacity -� Disposal Field: Distance from nearest well_._ _" Distance from foundation---t_(a__--------Distance to nearest lot line""._ � - Number of lines""_.__-_ --------Length of each line----'T--& + - - !'J ------- -"---Width of trench.---�r __-- Type of filter material_ ---=-----.""" . - -�,�,- _" ath of filter material-----/---$------" --.Total length----�-_�--�------------------------- El --__"-- � --• ------------ .� Seepage Pit: Distance to nearest well._.---------------,_"Distance from foundation-------------------Distance to nearest lot line"_.. "____--- ❑ Number of pits--------------------- on material-----------------------Size: Diameter--.----•_-- ' Cesspool: Distance from nearest well.--.----.__.-____ _Y x ---- Depth------------------------------- Distance from foundation------_-------------Lining material material- -".".❑ Size: Diameter--------------------------------------Depth----------------------------- ------------------------------- Privy. "__"""--____________-__-__ _ PrivY� Distance from nearest well------- uid Capacity -------- ----------gals. .Distance to nearest lot line-------- - ------------------------Distance from nearest building__---------------- ---_ ----------------- -------- ------ ________ __ Remodeling and/or repairing . .�. --------•-----------------•---------------------------"--•---------- ----------------------------------- F I hereby certify that I have epared this application and that the wot ill be done in accordance with San Joaquin County ' ordinances, Stat and ru_ and regulations.of the San Joaquin La Health District. �. i [Signe }•-- �:�-•ter.." -_----- ��__ . "T ------ -----(Owner and/or Contractor) By:•----------------------•-----------•----------• = - ----------------------- ---------------------------------------- Title ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY'-"----------------------- - DATE ----------------------------------------------- BUILDING REVIEWED BY ---------- ----------------=---- -� y°---------- ----- -------- ---------------- BUILDING PERMIT lSSUED______-_--•--'------------------- DATE----=-------- r z DATE "Alterations and/or recommendations________ �_ _ "" --- ------- --------•---------- �, -- ----------------"•------------------------•------- ---------- •--------•-------------------------------------- ------- ------•--- -----------1•---------- c 2._ -------------- ----- FINAL INSPECTION BY-4;_- 6 ----------------------- Date------- --------------------- SAN -- .---SAN � S JOAQUIN LOCAL HEALTH DISTRICT 130 South American, Street 300 West Oak Street 132 Sycamore Street Stockton, California Lodi $14 North "C" Street k , California Manteca, California Tracy, California ES-9 145446 ATWQnD ><