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�S 3 APPLICATION FOR SANITATION PERMIT Permit No. y Y (Complete in Duplicate) Date Issued �.- -------I5-- 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. 9. -------- - _ JOB ADDRESS D LOC TI� ----------------------------------------- --------- - Owner's Name_____------ ---- - -- ------ -- - --- -- --- - ------- ---------------------- - -------------------= - Phone - �f Address_..-----1.7__- --•---•--._ ------•------•------------•----•----------------------------•-----------•------- Contractor's Name--- ___-__ __- __- ------- Phone---------- -•------==------------- Commercial Trailer Court ❑ Motel ❑ Other ❑ Ins+alla+ion will serve: Residence Apartment House ❑ ❑ 1 l ! _x_�-1f�Q----------------------- f ___ Number of baths --- __. Lot size _ -- --- Number of living units: .--[____ umber of bedrooms Private ❑ Depth to Water Table ___.____ ft. Water Supply: Public system Community system ❑ Clay Loam Clay Adobe F iardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ y ❑ Y ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tar+k: Distance from nearest well_________________Distance from foundation-_._.____._________Material____-- Ca acit No. of compartments "' ize Liquid deP.t p Y c istance from foundation-- - Distance to nearest lot lig_ ly _ -- - ---- sal F 1 Distance from n r st 11 tuber of line __, s length of each line______- - Width of french__.____�T --- ---------- Type of filter materi '-_-- -- epth of filter material--_---�. ----------Total length-------- _0-------------• el!______________________Distance from foundation---________.__.___.Distance to nearest lot line----------------- Seepage Pit: Distance to nearest w ❑ Number of pits------------------ ---Lining material----------------------.Size: Diameter_________--------- - Depth--------------------------------- Cesspool: Distance from nearest well________________Distance from foundation------------ material_____.______------- ----gals. --Depth-------------------------------------------------- Liquid Capacity g 171 Size: Diameter--------- ------- --------- ----- Privy: Distance from nearest well-------------------------------------------------Distance ------------------ --------- ---- _--________Distance from nearest building---------------------------------------- -------------------- ❑ Distance to nearest lot line______________________________-_.____.------------------------------- ------------------------------ r Remodeling and/or repairing [describe):- -------- ---- ------ --------------------•---------- -------------------------•----------• --------- ------------ --------------•----------------- ---------•--- -------------_------;--- ----•-----•--------------------------- ------------ --------------------------------------------- -----------he------__ce ----------- -- - ! hereby certify that I have prepared this application and +hat the work will be done'in accordance with San Joaquin County ordinances, at laws and ales and egulatiorrs of San Joaquin Local Health District. t (Oand/or Contractor) (Signed)--- I •------------------- -------------------- • (Title) By:---------------------- ------------------------------ ( ) ------------------------------------------------------------ - (Plot plan, showing size of lot, Iota+ion of system in relation to wells, buildings, etc., can be placed on reverse si e. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ---------------------------------- �----------------- DATE_-e----•--------- ---------- ------------ --------- --- -- ------------------------------------------------ - DATE REVIEWED BY---------------------------- DATE-------- - BUILDING ATE------- - BUILDING PERMIT ISSUED--------------------------•------------------------- Alterations and/or recommendations:____--------------------------------------- ---------------------- -- -- --------------------------------------- -- -- ---------------------------------- ------------ ----------------- -------- ----------------- ------------------ - - �� Date---- ------I�--- ;-------------- ------------------------------------------------ ---------- �i" --- --------- - FINAL INSPECTION BY------------------- ---L--�-------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 132 sycamore Street 814 North "C" Street 130 South American Street 300 West Oak street Tracy, California Stockton, California Lodi, California Manteca, California ES-9-2M do-52 Revised W-210