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APPLICATION FOR SANITATION PERMIT Permit No.- (Complete o: (Complete in Duplicate) `, ,7 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 LOCATION _' - E_ A-�---"---------- ------------------------ Owner's Name �7W Address = Phone e� �s ?--------------------------------' /' ------------------------------------------------------------------------------------------------------ Contractor's Name -------------------------•--- Phone-- = © Installation will serve: Residence Apartment House ❑ Cgmmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1___~Number of bedrooms __I-_- Number of baths __/__ Lot size _45-40-- _?? -__L�?-`----------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a crepth of 3 fee+: Sand E❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobe Hardpan ❑ Previous Application' Made: Yes ❑ NoX New Construction: Yes ❑ No ❑ � ,L, I TYPE OF INSTALLATION AND SPECIFICATIONS: T (No septic tank or cesspool permitted if public sewer isavailable within 200 feet.) '*\ ,�,`ptic Ta : , Distance from nearest well_______________Distance from foundation--------------------Material _______-_____. , {Q No. of compartments-----------A`t--�-------------Size--------------------------------Liquid depth----------------- -Ca acit Disposal Field: Distance from nearest well-'_ �P�-_Distance from foundation-9--l"-____.__.Distance to nearest lot line-___,j ,.� Number of lines_---____�_____r Length of each line____s "0_ -------Width of french e -------------- Type of filter material__)_ ____Depth of filter material-__._--- -----Total length---,A __'________________ I s epage Ni Distance to nearest well----------------------Distance from foundation--------------.____.Distance to nearest Eot line-_________-__._- . a -- t..-- Number of pits-- ------------------Lining material-----------------------Size: Diameter-----------------------Depth------.-------------------------- j` Cesspool: •e� Distance from nearest well--------_--------Distance from foundation--------------------Lining material-_______---- -___________________- ❑ Size: Diameter---- ---------------------------------Depth--------------------- ------------------------------Liquid Capacity--------------- -------gals. Privy: Distance from nearest well---------------------------_---------------------Distance from nearest building------------------------------------------ Ell _--------___________________---_-- - -❑ Distance to nearest !of line -------------- Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------ -------------------- ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------ --------------------------------------------------------- I hereby certify that I 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. I - Si ned ( 9 )------ - '---/-- '---------- - ------- , ------=_ `-------- Owner a d/or Contractor) B (Title)_ - ------ ---------------------------------------------------------------- _ � � (Plot p n, s g size of lot, location of s em ' relation to wells, buildings, etc., can be platted on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY<`______-__ DATE__` --------------------------------------------------- REVIEWED BY------------------ -------- � _ - DATE--- BUILDING PERMIT ISSUED------------�-------------------------------------------------------------- ---------------------DATE---- 4'�,�A- Alterations and/or recommendations:-I-------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------=-------------------•---------------------------------••---------------------------- --------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- --------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------�---------------------------•------------ FINAL INSPECTION BY:-------L__` ----------------------------------------------- Date / - f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised W-2100