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APPLICATION FOR SANITATION PERMIT Permi- fi No. .. (Complete in Duplicate) 7 Date Issued __ lic pp cation Eon is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i his application is made in compliance with County Ordinance N . 549. JOB ADDRESS AND LOCATION..I-------- - �Q �• -----------•----------------•------ -------------------------- Owner's Name ------ Phone--- ---991117 - - --- --------------J;� ----- ------------------- Address- s.e._._ Contractor's Name Phone...... t Installation will serve: Residence jg Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units. __/___ Number of bedrooms Number of baths __ ____ Lot size ___ �' r Water Supply: Public system g- Community system ❑ Private ❑ Depth to Water Table 1714�t. Character of soil to a depth of 3 feel: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑ Previous Application Made: Yes ❑ No f New Construction: Yes ❑ No ❑ �/ ` e TYPE OF INSTALLATION AND SPECIFICATIONS: >. , �c...4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S tic Ta Distance from nearest well--------------.__Distance from foundation--------------------Material ___.____...__.__..-_______________----__ q No. of compartments---------- ---------------Size--------------------------------Liquid depth--------------------------Capacity---------- ------------ osal it Distance from nearest well------------------Distance from foundation--------------------Distance to nearest lot line Q Q I Number of lines-----------------------------------Length of each line---_--------------------------Width of trench----------------------- . -- -------- � 9 Type of filter material-------------------------Depth of filter material--__-- Total length--_------------------------------------ Seeps a Pit: Distance to nearest well__ io-OE--Distan rom fou tion_ i_+ -. _Distance to nearest lot line_.�'D_R__-._ Number of•pits._-_.___.__.______.Lining material ___�(f _S ei Diameter_.._ �t_--Depth � Cesspool: Distance from nearest weft _Distan from foun tion__---__.___-_,____.Lining material___.__-__________._.___._ ❑ Size: Diameter__1--------------------------------Depth-- -- ---- ------------------ -------------Liquid Capacity------ ------------- -------gals. Privy: Distance from nearest well ___--_--------------------------______________Distance from nearesr building____._.___.__.__-___-_ El Distance to nearest lot line___________________ --------------- Remodeling and/or repairing (descri be)--------------------__----------------__._ --------------_------------------ --------------- •-------------- ----------------- -" - --------------------- _. __________.__.__.____.-________________________3__..____-_-______----_________-____ _______________________________________________________________ ____ I hereby certify that ve ared this application and at the work will be done in accordance with San Joaquin County ! ordinances, State laws, an rules an egulations o the San J aquin Local Health District. (Signed)_ ---- ----------------------------- r Contractor] BY: --------(Title}__ Ne ��- rrs+_ ------------------------- P of plan, showing size of lot, location' of system in relation t ells, buildings, c., can be Iced on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-------- r DATE # + REVIEWED ----------- BY--------------------------------------------- -- ------ DATE .- I 13------ BUILDING _7- PERMIT ISSUED-------------------------------------------------------------------------- --------------------------- DATE Alterations and/or recommendations:------- ------------------------------- ------------------------------------------------------------------------------ ------- ---------------------------------------- ---------•-------------------- - ------------------- -------- ......I -- -----------------------•-------------------------------------------------------------------------------------------------------------- I /off --- , FINAL INSPECTION BY:.______.__ �'' l `' '� Date . - _._ . 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