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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate)..,- Application uplicate)..,-Application is hereby made to the San Joaquin Local Health District for a permi This application is made in compliargc�L wif�,,County, Ordir rN�. 549. E ��% Permit No. Date Issued lO / and install the work erein described. JOB ADDRESS AND LOCATION ---- �- `� - - -- : - �� _ ------------------- Owner's Name ----- Address ........ --- Address_---•--1----------------------------------------------------------------------------------------------------------••---------------------------------- Contractor's Name----- -•------ -- ------------- Phone----------------------------------- Installation will --serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/ Number of bedrooms ___ Number of baths __/_-_ Lot size ---- 6�q--- X_l ZD_______________________' Water Supply: Public system 01--lCommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay E]Adobe lardpan Ely Previous Application Made: Yes E]No E]New Construction: Yeso ❑ PHA/VA: Yes ❑ NoJ�j� 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_. ___-__istance from foundation_f0__r_------- Material ----- h --HCl------ 4 No. of compartments ---------- '.%__---________ Size ------ '-- -_ -Liquid deptth�___--_.-_....._______,_Capacity__�b_� ,. Disposal Field: Distance from nearest welll_-Ld�i�Distance.from foundation_---/Ah,-Distance to nearest lot line__ _ ❑ Number of lines__- Length of each line -------- `L_P- -------------- Width gf,french -----�------------------- r mater_ial__�Y--- ---------otal 46,n,~ h___ __________________ _. Type of filter material__ De th of filte Seepage Pit: Distance to nearest well ---------------------- Distance from_ foundation-------------------- Distance to nearest lot line --------------- - ❑ Number of pits ------------- --------- Lining material ------ -_ -- ------____--Size: Diameter___________________ -.Dept h -------------- ---------------_--- Cesspool: Distance from nearest well ------------ ----- Distance from foundation -------------------- Lining material -_-____-___--------________._________- ❑ Size: Diameter ------------------------------------ Depth --------------------- -----------------------------Liquid Capacity ---------------------------- gals, Privy: Distance from nearest well_________________________ ___.___________Distalnce from nearest building __________._____________________..____._.- ❑ Distance to nearest lot line--------------------------------------------------------=----------------------------------------------------------------------------------- Remodeling and/or repairing (describe)---------------------------------------------------------`-'"-----±--------•----------- j---------------------• --------------------------------- 'j'-------------•-------•---------- --------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- 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.,, ed C . (Owner and/or Contractor) (Sign' ) jam:'•-�� ¢ ------- By: --------------- ----------------------------------------------------------------------------------- ----------------- - itle)---------------------------------------------------------------- (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 APPLICATIONACCEPTED BY-- ----------- -- - ----------------------------------------•----------------------- DATE—'z --------------------------------- ----------------- REVIEWED BY--------- ------------------------------------------------------ DATE---- _K- -------------------------- ----------------------- BUILDINGI� PERMIT ISSUED------------------------------------------------------------------- _ DATE----- -------_---- ---------------- AI eratio�is and/or recommendations:: " ` ------ #---------} f>3 ------------------ ------- ' ' ° -- --- k� ,- g_ �e � ZFs-- `- --`- --- ----------- -------#---- ---- ------•------------------------------•--------------------------------------- 4 FINAL INSPECTION BY:------- Date ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES -9-2M Reviseci 1.57 F.P.CO.�-