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APPLICATION FOR SANITATION PERMIT Permit No. .___f�.j_�.._.... (Complete in Duplicate) 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 Ordi nce_No. 549. JOB ADDRESS 6NO LOCAT ON ? W --- •---- ---- --- -------�------------------- �} v drOwner's Name--- -- --- ---- -''__�` I ---------------------------- -'� - -�V.---------- Phone_ f s'7 Address---------- _- ------- --------I -------------------------------------------------- Contractor's Name----- --------------------------------- Phone..------- ------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ M++o#�I ❑ Othy ❑ Number of living units: ______ Number of bedrooms _ — Number of baths --�--- Lot size -�O?___-_X_- ZC5___________________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: S;��New,-Constru Gravel F1 Sandy Loam Clay Loam ❑ Clay E] Adobe [Hardpan E] , Previous Application Made: Yes E] No ction: Yes [ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest we. fro .fo tion---_�-_Q_--___.__:Mat riaL_ fi + _____ ___}___ No. of compartments_________ ____ Size__r�_ _ ____Liquid I�th_______ ___'________Capacity..- ,�C Dis vs I Field: Distance from nearest wel - . - Distance from foundatio -- !_______Distance to nearest to lin _ --____. Number of lines__________ _ ___ ----- Length of each line---_�{ _ff __ ______.Width of trench__ __ ____ ._ _Type of filter materia epth of filter material ________Total length- _____________________ Seepage (\ Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------.----- ❑ Number of pits---------------------Lining material--------------- -------Size: Diameter--_- -----.Depth----------------_---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_______________________________-. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity--------------------------- Is. Privy: Distance from nearest well-_____________________________________________Distance from nearest- building__-______________--__________-_____. ❑ Distance to nearest lot line------------------------- --- ---------------- ---------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- - -- - - -------------------------------------------- --------------------- ---------------- --------------------------- --- - ---- - ---- -------- ---------- --- -- I hereby certify that 1 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 (Owner and/or Contractor (Signed) = - --��•--. ��----- -_-C---�=–,r----��-�:--t-�-d--��P'---------------------------------------------________(O / ) By:------------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------- ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____---._-__ - --------------------------------------- ----------- DATE_____.__ i - --------------- -------- --------------- REVIEWED BY--------------------------------------------------------- ------------------------ ------------------- DATE---------------------------- -------------------- ---------- -- BUILDING PERMIT ISSUED------------------------------------------------------------------•-------------------------------- DATE----------------------------------------- -------------------- Alterations and/or recommendations.--.-- .�— -----•----- -------------------- 1 r---- - --------- r -------------------- S! '' -----I-- --------------------- ----,----- - --------------- --- ------------------------- --- a-_ ---_-- :=_ :: . : :::::::::------_------::r; .{ r - -' � ------------------- FINAL INSPECTION BY:--------------------------------- �NL �AL Date--------------- S ---- -- a. y .. ---------- FINAL � 4 SAN JO E ZTFT�OTSTRICT „ € ..a k -, 130 South American Street 300 West Oak Street 132 Sycamore Street � y 814 North"'C"Street. Stockton, California Lodi, California Manteca, California ., `~ Tracy, California ; !. i ES--9-2M 8-51 Revised W-2100 }, [la f r �'