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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .-_____-- AFplicafion is hereby made to the San Joaquin Local Health District for a permit to construct and i sial he�ork heredescribed. This application is made in compliance with Gounty,-Ordinance No. 549. � 4 JOB ADDRESS.AND LOCATION________ Owner's Name------ (# U r --- � * Phone -- -------• _2�-------•-- ' ----------------- ----- ---------- --•------------ ------ Contractor's Name_� -- _ 0 ------------------------------------------------------------------------------------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Metal, ❑ Other ❑ 3 � !Number of living units: _�___fNumber of bedrooms I. Number of baths ___�__ Lot size --- __: ___________________________________ Water Supply: Public system [? Community 'system'❑' Private'❑ 'Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: F Sand [j Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay D Adobe F Hardpan ❑ i Previous Application Made: Yes No l ❑ New Construction: Yes �No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic se `r is available within 200 feet.) s Septic an k: Distance from nearest well--^f DzeaA S { }ion/f„�-__ _ _�_Material_c____-_-; - s r { o. o com arfinents____-_ -_. _ ------- ----n-.___Liquid depth-�---•----�'-----------,Capacity-- - - --'��.-- Dis© ! Field: ---- Number'of linesearest II __-" Length of each foundation_�_�_ ' ante to nearest lot line_:_- '�` Disposal r rf g h line------------- - ....Width of trench------- -.�# -- or' filter material_ ` Depth of filter material-------- __;,_-._Total length----------: �� --------------- Seepage _-- -_-_. --Seepage Pit: Distance to nearest wailDistance from foundation-------- :.Distance to nearest lot line-_____-____-__-__ ❑ Number of pits ------Lining material--------_-----------.Size: Diameter------------------------Depth---------- ------- . Cesspool: D?stance from nearest well------------------Distance from foundation-----_--------------Lining material--- ----• ------=-------------------� ❑ Size: Diameter----------- !--------- Depth---------------------------------------------------Liquid Capacity----------------------------gals. : Privy: Distance.from nearest-weN-----------------__-__________ __ _ "`__Y___.-Distance from nearest building , 171 �..m .. ... .. g ------------- Distance to nearest lot line________________________________ ., Remodeling and/or repairing (describe)___________________________________ _ ---------------•--------------- -----------------------•---------- - -- ------ ----- ••--- - •-- --- -- --- ------ - - ------- --- - - -- 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. (Signed)--- -;;t___..: ---------I--�--------------- �-�"`� =---------------- ------ ------------------(Owner and/or Contractor By�-� •. ----------------------------------------------------------- 0 I • } , ---- ------------ ---- - --- ] a (Plot plan, showing size of lot, locafion of system in relation to wells, buildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWED BY- ------------------------------••---- � � ------------ -- '"-- � _J*' .�:_�_�___l-3' __`-•____ye- -_--__y__ __• DATE a ----------------------------------------- DATE---�BUILDING PERMIT ISSUED ------- -- ------------------------------------------ Alterations d/or recommendAionsDATE---- � •-•__•_ -------------- ---------------- _____--_____. ___________________ _ -------••.------•--__ ______________________________________________________________________________________________________________________________.__._ _________________________________________________________________________ i FINAL INSPECTION BY:---_----------_........._----------------- ---------------•----- - Daae-- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Y 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M ; Revised W-2100