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�� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate} ` � Date Issued --- �i Applicakion is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein described. This application is made'in compliancy with County Ordinance No. 549. 4 * a - -- -------------------- JOB ADDRESS AND ATI G„ _ ------._._: Phone . Owners Nam ---- - :•- •• -- - =t------�-�-- ----• --- �-- - .- _ •. r� Address.- - `= - ----- ------••-- ----------------•---`--"------------------ Y x . ... ------------- Phone-,-- Contractor's Name_________ _____ - :32 `'f------ --------------------------- �= f ^� 1 Commercial Trailer Court ❑ Motel Cj 'Other ❑ Installation will serve: Residence Apartment House ❑k`I E Number of living units e __ lJumber of ,bedrooms �__-Number of baths-_ Lot size ____ �- Q--------------------- ` Depth to Water Tabl�O ft. Water Supply: Public systemCommunity system ❑ Private ❑ Dep - Character of soil to a depth of 3 feet: Sand ❑ Gravel [:] Sandy Loam E] Clay Loam [3Clay E] Adobe Hardpan E] Previous Application Made: Yes ❑ NoX New Construction: Yes' No E] , e TYPE OF INSTALLATION AND SPECIFICATIONS: �// �� (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Distancefromf undation_/ -"�--.Maui l_ -�r� F-------- Septic Tank: Distance from nearest weil f . P t Ca acit ._ ��___ No. of compartments-----------------Size_ _. � _ _Liquicl depth__---- --; - P, Y Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----y--`_____-__ ❑. Number of lines--------------- ----------------•--Length of each line------------------------------Width of trench-------k ---------- {----------- Type of filter material-------------------------Depth`of filter material_---------------�----Total length--------.--------------------------------- Distance fr m ou ation_ ________________.Distance to nearest lot line----- .--- Seepa e Pit: Distance to nearest well_ - Q� -V g Size: Diameter_,W'---------.De #h Number of pits.___-.--- ----__ Linin mater 1 p - Cesspool: Distance from nearest well-."_--___-_-.___Distance from foundation----__-________-"_.Lining material_________________"_ _________-___. De th-------------------------.---------------------------Liquid capacity----------------------------gals. ❑; Size: Diameter---------------------------- -- p (.� Privy. Distance from rearest well--------------------------------------------------Distance from nearest building g --------------- --- ------------------- ❑ -- � ----7-1------------------ --------- ----------•----•---- Distance to nearest lot line-------------------------- _ Ja- - ---------- ` "- --- Remodeling d/or repairing (descry % f ' ------------' - --------------------------------- _ ____ -_ ___ _ ------------ --------------------------------------- ....._--------------------_-"__-� ____"______________________________________________________".___________._.____________._.._______"___' _ � ____ ______________ ____'_____. ___ J ------------------------ _____________ if 1. l hereby certify that I have prepared this application and that the work will be done in-acdordance with San Joaquin County ordinances, S t laws,' d ules and regulations of the San Joaquin Local Health District. I ) (Signed)---- e--l- ---- -----`---------------------------- ------------------------------------ •----- (Owns Contractor) �-and/or Cont or .- r an BY: ------ ------ ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sidle. � , A 1 FOR DEPARTMENT USEONLY APPLICATION ACCEPTED BY-------------- ' -` - ------ - --------- ------------------------ -------------- DATE--- --�- DATE.--- . REVIEWED BY-------------------------- -- BUILDING PERMIT ISSUED----------------- - ------ DATE--------------------------•-------------`-----•------------- ------ --- ------------------------------- . Alterations and/or recommendations:----------------------------------------------- ---------------------�---------------------------------------------------------------------- •------------------------------------ ---------- j ----•------------------- ._----------------------------•-------------------------------•--------------- -------------------- I --------------------------------------------------------------------- I - - - FINAL INSPECTION BY:____ _- -�C------- -------------- ---------- Date- �- `� `� SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 134 South American Street Trac CaliforniaStockton, California Lodi, California Manteca, California y� ES-9-2M Revised W-2100