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APPLICATION FOR SANITATION PERMIT Permit No.d._ -_7. 7 (Complete in Duplicate] Date Issued tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t,A 4 ' s application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION-------e-7 r ------- - ----------------------------------------- Owner's Name � � z.e..... --• - Address - ------.... --------------------------- ------ Phone-------------------- -------------- --•---------------- ------•------------------------•---•-----------------------•------------------------------------------ Contractor's Name ------------------------------- Phone--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court El Motel Other Motel 7 ❑ Number of living units: Z-_ Number of bedrooms -4- Number of bathe Water Supply: ,r---- Lot size _____7 - - -- ---1�---t-�'�----�---------------- Public system 19 Community system ❑ Private [] Depth to Water Table Via_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (' Hardpan ❑ Previous Application Made: Yes El No V' New Construction: Yes [:j No L] � ,r4, µy TYPE OF INSTALLATION AND SPECIFICATIONS: 4' ��'��' 12 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic Tank: Distance from nearest well_________________Distance from foundation------------ 1 •------.Material-- --------------------- --------- -----------� No. of compartments--------------------------Size_-------------------------------Liquid depth----------- ------------- Capacity---------------------sal Fi�(d:i Distance from nearest well_ __.Distance from foundation--------------------Distance to nearest lot line.____ '�c•--7 Number of lines-------- ---------------------------Length of each line------------------------------Width of trench-------------------- - Type of filter material------------------ [[ -------Depth of filter material-----------------------Total length-------------- Seepage Pit: Distance to nearest well_- lU-IL� Distant fro fo ndation_�. �.-._-- ��jj __..Distance to nearest lot line_--5^- _ Number of pits.__-/_______________Lining materialC-- �---Size: Diameter___.----.-. _- p --__ +�" - --De th_ ----------- Cesspool: Distance from nearest well___-________._-_Distance from foundation__________________ Lining material------------------------------------- Privy: Size: Diameter----- ---------- ---------- -------Deoth- ------ ------------------------ ----------- ---Liquid Capacity q ----------------------------gals. El Privy: Distance from nearest well__ ________ ______________________--.-Distance from nearest building to nearest lot line__.__-._______.___-_______. _- -------------------------------- Remodeling and/or repairing (describe):_____________________ _ --- ------------------------------------------•------------•------•-- -------------------------' --------------------------------------------------------------------•---------------------------------- ----------- -- I hereby er i that I have pared this application and that the work will be done in`accordance with San Joaquin County ordinances, S to I s, and rules%d regulations of the San Joaquin Local Health District. (Signed) -- -------------------- -- -------- --- --- -- ------ 8y:. -----------------------................. 0 or] (Title]---- cR. - -�Z- --------------------- (Plot - ----- - - _ plan, showing size of lot, location of s n relation to wells, building , etc., can be piaEed on�reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------------------------- 2 `� DATES - - ,3----------------- REVIEWED BY ------------ } ---------------------------------- -------------------------- --------------- DATE.- i - BUILDING PERMIT ISSUED_______ _ --------------- --------------------- -- ----------- DATE. Alterations and/or recommendations_____ -------------------•------ -------... ------------- -------•------=-------------------•----------- z ---------------------------------------------------------------- --------- -------------- A- FINAL INSPECTION BY------------- ---- 1 ;►fAt ----------'----------- 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