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APPLICATION FOR SANITATION PERMIT Permit No, _;7-_1-1-31__ �s i C m I F _ __:.... ( o p ete n Duplicate) _� Q �-� -� Date Issued ----q `� Application is hereby made to the San JoaquinLocal Health District for a permit to construct and install ll the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND LO AT N__. l . . Owner's Name------------ - � --------------------- / ----- -- --- ---- - Address FL Phone 9 _ - --___---•---------- --_----I Contractor's Name_______________ - � _-•_-- _-__-• 0 ---- Phones/ {`J • Installation will serve: Residence Apartment House [] ommercial ❑ Trailer Court E] Motel � ❑ Other ❑ ! Number of living units: _ mber of bedrooms_ _-- Number of'baths, __•Lot,size Wafer Supply: Public system Community system ❑ Private-E] .Depth,to-Water-Table ______-- ft. Character of soil to a depth of 3 feet:I Sand ❑ Gravel 0 Sandy Loam-❑, Clay Loam ❑ Clay Previous Application Made: Yes ❑ No ❑ New Construction:' Yes ❑ -No El - [I Adobe Hardpan TYPE OF INSTALLATION AND SPECIFICATIONS: x x (No septic tank or cesspool pedniffed if public se is available within 200 feet.) Septic Tank: Disfance from nearest welf-A Distanc from.foundation_ Fir ----- .Material --�✓ � No, of compartmehfs---_ ---___-S-x �- - - �� -Liquid depth. ------------ x ,,�� JJ _ . .� ., CapacitY1�_-a r Dis o ai Fi d: Distance from nearer well#!-Y!3 ,Length of e m foundation -1�____-_Distance to nearest lot fine .m p Number of lines_-- � _ _ � " � �---•---•---- ach Width of trench_- 7r----_ _ Type of filter material. -(1---- / - : ,f JDepfh of filfer material-__-A_ __p:___Total length__--_. Seepage Pit: Distance to nearest well�YLf. 1 f _-_ Distance frm ouncl fion----- __--_-_.Distance to nearest lot line---- p Number of, its _ ,� �,f . Lining material_ _ 1ze: Diameter------ Cesspool: -- ---------.Depth---�--�-----------•- Cesspool: Distance from nearest well---------------- Distance from foundation....----------------Lining material_---__--._-__--_---__----__..-_-- ❑ - _ Size: Diameter--------`--------------- ----- Depth----------------------------------------------- Liquid Capacity----------------------------gals m Privy: Distance fronearest well �._., _ .__ . -------------__Distance from nearesf_building J ❑ Distance to'nearesf lot line � ------ --------------------------------------------------------- Remodeling and/or repairing (describe)---------- -- -- ', i �• --- ------- ----------------------- ---- -- ---------•- ------•f •------------------------------------ p --------------------------- --------------------------------------------------- --------------------------------------- ----- I-----------------•------------•---------------------------------- Y -------•---------------- I herebycertify that I have prepared this a lication and that the work will be done ,En accordance with San Joaquin Count ordinances, State s, an rules and;Pflulolons of fhe n Joaquin Loca ealth Distr t. (Signed)--- -- ---- `i f .------------------------ (0 1br and/or Contractor ------------------------------------------------------=-- -----------{Title)------ D---- - {Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ --- ----- .� ----------------------------- REVIEWED -------- =- --- ---------- 'DATE---------------------- --� `?'' �- ° BY.'-------------------------------------------- ----- - - ------"�---------- DATE------------------------------------------------------------ ------------------------------ -------------- PERMIT ISSUED ____ - ---•--------------------------- -------------- ---------------- ----- DATE Alterations and/or recommendations:__._-__ __ r �* ----------------- --------------------- ----- -------- .r -------------------------------------------------------- FINAL INSPECTION BY:- Date- r -� 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 8-51 Revised W-2100