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` Permit No. APPLICATION FOR SANITATION PERMIT . " to (Complete in Duplicate) Date Issued ---al-_!_ .3 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 Ord' nce Nd"�54'9. JOB ADDRI S LOCATION --------- -----------•----- ------------------------------------------------------------- ------------------------------------------------------ -------- Owner's Name ni� Phone _---_0_�-_--- ---0 ------- ----- ---------------------------------------------------•-•------ Contractor's Name----- --- -- ----- - _ __ ------------------- Phone------------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailef Court ❑ Mojej ❑ Other 9 Number of living units: __!"____ umber of bedrooms 0_ Number of baths .�_-""r Lot size _-"7._ � 0 Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. and Gravel Sand Lo; No Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: S ❑ ❑ Y Previous Application Made: Yes p No )/ New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sew r is available within 200 feet.) l Septi ank: Distance from nearest well___ _�ist q fr fo ndc6n_._�{/__" ""_ ater' "__"_ ____""."--- d __. �( { y ------ stance ' No. of compartments ? - ]cI "''1 iquid dorptM '`C-- Capacity ante from nearest weli �istance from foundation ��istance to nearest lot line"_ Drspos Field: Dist r *' [[ Number of lines---------- of each line_ !? "_" _-_-_ Width of french--------- -___---- 4 if Type of filter material.c;:"_'�___�- Depth of filter material-----__I__---------_Total length __ _V_________ _-_-_--Distance from foundation--------------- to nearest lot line----------------- Seepage Pit: Distance to nearest well__""""""______ Q ❑ Number of pits----------------------Lining material------------------------Size: Diameter-----------------------Depth--------------------------------- 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------------------------------------------ � ❑ Distance to nearest lot line-------------------------------------------------------------------------------------•--:------------------------------ --------------------- Rem Jelin and/ r repairing (des i e):_ -__ ____ __ I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ` ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. " °�_�-----------,- ------- --(Owner and/or Contractor) (Signed) r------------ --a-------- ____ :w, � ------------------------------(Title)-----------------------------------------------------:---------- w By:. ---------------------------------------- ------ ......................... ------ - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). b. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- ---------- -------- ! --------------------------------------------------- DATE-------- r------$-------------------- REVIEWEDBY------------------------ - --------------------------------------- ------------ DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------•----------- --------------------------- DATE------------------------------------ ------------- Alterations and/or recommendations----------- ----------- ------------------------------------------------------------------------------------------------------------- ---------------- --------------------------------------- -------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY----------------------- --- ----- Date - s� - ---------- z SAN JOAQUIN LOCAL HEALTH DISTRICT j130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100