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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) y Date Issued _�_'-------------- Application is hereby made to the San Joaquin Local Health D'sstrict 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 LOCATION__--14a,5=:�r�--------_1/V .........7---------��- Owners Name__________ f-Y- -YY---------------- --------------------------------------------- Phone__" C --------------------------------- Address-_ - - ---- -- Contractor's Name__.___.-`- =---_ Installation will serve: Residence Apartment House F1Commercial E] Trailer Court [I Motel ❑ Other El Number of living units: 07W—Number of bedrooms _-- --- Number of baths -------- Lot size ------------------------------------------------------'----- ' - Water Supply: Public system Community system fl Private ❑ Depth to Water Table�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ -� Previous Application Made: Yes ❑i No 9 New Construction: Yes.❑ No r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material-------------------------------------------------- No. of compartments Size-----------r-------------------Liquid depth--------------------------Capacity---------------------- ❑ ' �� Disposal Field: Distance from nearest well_fYe_(a e,__.Distance from foundation___ __ Distance to nearest lot line__ 1 Length of each line_-- ----- Width of trench--,-2--/.. of lines----�_1 �_ g ��"" r Type of filter material_ __K4_��_Depth of filter material___" --___- -_--Total length_-----e --__-f--------- See age Pit: Distance to nearest well_ J -----Distance from foundation___7-0--------- to nearest lot line_____ Number of pitsfj_/�Q�--------Lining material_.I�_ I-' �'�Size: Diameter__ Depfh- Cesspool: Distance from nearest well___-_____-_____Distance from foundation__________________Linu d Caateacirial gals. " Size: Diameter --------- --------------Depth_-------- :_ :: _ 9 P ty------------------------- 11 --' ' _ Distance from nearest building Privy: Distance from nearest well----------------------------•------- ❑ Distance to nearest lot line---------------------------------- --------------- --------------------------------------------------------------------------- ------ - Remodeling and/or repairing (des Tribe) �1""i'-b-I--r1-a-jv H--�---------------------3_JQR1N _. I --------•---- -------------------------- --------- --•------•--------------- •---------------------•---------------- -------iJ•--------------•--------------------------------------------------------------------------------------. ---- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a laws, and rulesf_ d regulations of the San Joaquin Local Health District. _ „ Owner "d/or Contractor) (Signed)_... -•--A RC1--------------------- By:-------------------- -- ------------ ---�4'-'-�--- -----------------------------(Title) (Plot plan, showing size of lot, location of system in ref tion to wells, buildings, etc., can be plac4d on reverse side). FOR. ARTMENT USE , NLY APPLICATION ACCEPTED BY_ �� • -- DATT�,;o -------- -•'�`�----a- - - ------------ '-` DATE REVIEWEDBY-------------------------------------------------------------------------------------------------------- DATE t a - --------------------- -e------------------------- --------------------------------- BUILDING ------------------------- ' BUILDING PERMIT ISSUED--------------------------•--------------- - Alterations and/or recommendations:"_-_____________________"-______. --------------------------------------------- ------------------------------------------------------------------------------------------------------ ---------------------------------------------- --- -----' --- -------' '�o --------------- FINAL INSPECTION BY:_1 ------ -------------------- --------�-- Date---- ---------- -------'- ---------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes* Oak Street 132 Sycamore Street . 814 North "C" Street }30 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9-2M 8-51 Revised W-2100