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�I,+►T1 N FOR SANITATION PERMIT Permit No. ---q-�.__ ---- (Complete in Duplicatel -s''l ` Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND r_. - --------------- Owner's Name----------------------- -------- -------------------- -------------- ---------------- Phone-----a- -ok.q ^__ Address-------------------------------------------- a ------------------------------© Contractor's Name------------------------ Phone---`,7..-=1-�-47------- Installation will serve: Residence IA Apartment House ❑ Commercial ❑ Tiler Court ❑ Motel ❑ Other ❑ Number of livingunits: - -- Number of bedrooms � 3 -- Number of baths ------ - Lot size -----� -------------------- Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table4!F`ft.f- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z�(-_Clay ❑ Adobe Hardpan Previous Application Made: Yes ❑ Nojg-- New Construction: Yes ❑ No ❑ ,R /,��, _ A� �; TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) $ c Ta • Distance from nearest well-----------------Distance from foundation--------------------Material----.----------.---.--------------.--__.----__._ No. of compartment-s--------------------------Size--------------------------- ---Liquid depth--------------- ----------Capacity-•.-------------------- i_ sal F' i Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line_----_-----.----- Number of lines-----------------------------------Length of each line------------------------------Width of french-------------------------.--------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ See a e Pit: Distance to near es well_&&--. -------Distance fr90n fo ndation_- - ._-___ D stance to nearest I t line-__ ----_. .01 Number of pits--- ---------------Lining material& ---Size: Diameter""-..----Depth- -----.- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------- -----.--.-------.___------. ❑ Sze: Diameter----- --------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals.,* Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------ ------- _. ❑ Distance to nearest lot line---------------------------- Remodeling and/or repairing (describe)---------------------------------------------------------- -------------------------------------•------------------- ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------- •----- -------- ------------------------------------- -----------------------------------------------------•-------------•------------------------------------------- I hereby certify th I e prepared t4s applic ion that the work will Joe done in accordance with San Joaquin Count ordinances, State d rules d re ions of a an J a uin Loc I He h District. g q � Si ned ------------------------- -- r Contractor { 9 } ------- -- -------------- -- {e� } BY: (title) --�—� Gs.+�-----------� (Plot plan, showing size of lot, location of syst in re i to wells, buildi , etc., can be placed on reverse side). FO EPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------------------------------- DATES----------•-------------------------------------- REVIEWEDBY------------------------------- -- - ----------------------------------------------------------------------------------- DATE--�� VS ------•------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------•--------•-------------------- DATE---------V------------------- Alterations and/or recommendations----------- --------------------------------------------------------------------------------------------------------------- ----------------•------------------- ---------------------------------------------------•------------------------------------------------ --------------•------------------------------------------------------•----------•-•--------------•---------------------- --------------------------------------------------------------------------------------- ------------- -- --------------------------------------------------- --------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------. ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- FINAL INSPECTION BY:----------------------lf----f��' - 'ti'----------. Date_-.-y __ --------------- 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 M-52 Revised W-2100