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V APPLICATION FOR SANITATION PERMIT Permit 9' (Complete in Duplicate) Date issued 4) ,, 15-7 --rro— o Application is hereby made to the San Joaquin Local Health District for a permit to construct and install 4e work herein described. This application is made in compliance with County Ordinance No. 549. JOB r, DDRESS AN OCATION... - --- - ----- '- _ -------------------------------------------------- ------------------------------ - 9---- Phone Name qq -------------------------- Phone +/ r✓ 444� Address --------- ---- < --------- = / �+ i Contrac:tor's Name------0.�- '-••-?.GVtllls4�# ".3 v�---------------------------------------------------------------- Phone-------------------•-.------------ Installation will serve: Residence ❑ Apartment House ❑ Commercial K Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _- _____ __ Water Supply: Public system' Community system )] Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobex Hardpan-0 Previous Application Made: Yes 21 NoA New Construction: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N;. .$wpiVwe•:� Distance from nearest well ^t._Distance from foundation_____ r /.� --------.Materia l !��'��:l�fr�_r Liquid de th__- � w`__Ca Pa da----___ . �.. No. of compartments--------r/--------- Size------- ------ - q p � --- --=---r--- P Y-=-�- W ------- Disposal Field: Distance from nearest well______________-_-Distance from foundation--------------------Distance to nearest lot line__________.._-___ p Number of lines---------------- ------------------Length of each line------------------------------Width of trench------------------------ Type ------------------________--_-- Q Type of filter material_________________________Depth of filter material----------------------Total length------------------------------------------ See a e Pit: Distance to nearest well--�^'_"�t. _Distance from foundation__..L_0_.---___.Distance tonearesthoot pline ��42 e Number of pits_________________Lining material_ __ __ Size: Diameter____ 1'__!_________________ 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� �r14- -_line----- ------------------------ -----------------------------------------------------------------------------------------• --- --------------- Remodeling and/or repairing (describe):____ 4 ______ _ -� �""� __ f �-E��---- `__..41 -------- ---4.------ ----------•---------------------------------------•---------------------------•------------------•---------------------------------------------------------•------------------------- -------------------•--------------------------•----------------------------------------------•-----------•--------------------------------------------------------------------------------------- - 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. t (Signed)___PE �!------- v `�,�------------------------------------------------------- ; or Contractor) By:--- ---------------------------------------------------- p------------------(Title -------- --- -- --------- ----------------------------- }-------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--V____ ---------- ------------------------------------------------------------------ DATE--Y ------------------------------------------------- REVIE4VEDBY------------------------------ ------- ---------------------------------------------------------- DATE------- y BUILDINGPERMIT ISSUED-------- ---------------- ------------------•--------------------------------------- DATE----------- �,�----------------------------------------- Alterationsand/or recommendations------------------------------------------------ ---------------------------------- ---------------------------------------------------------------------------- --------------------------------------------------------------------------- ------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_ 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-9-21A B-51 Revised W-2100