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APPLICATION FOR SANITATION PERMIT Permit No. " (Complete in Duplicate) - 7 Date Issued ._` --3_-__••-. Appliceion is hereby made to the San Joaquin Local Health Distric This application is made in compliance wit � t for a permit to construct and install the work herein described. h County rdinan� No. 549. JOB ADDRESS AND L CAT " ION-� -------------------------------- -------------- (� Owner's Namer �/ � �._• .f�uJ7.� _ — iE� Phone-- ----- .... Address-------- --------------•---------------•-------------------------------------•-----------------•- - ----•--- Contractor's Name - ---- 1-------------------- ----- - -- ---------------------------- Phone. Installation will serve: 'Residehce Apartment House ❑ Commercial ❑ Trailer Court ❑ M�o el ❑ Othert � Number of living units: :._.._-. Number of bedrooms -_ ... Number baths -1--- Lot size ----------- ----------------------------•- Water Supply: Public'system''❑ Community system'❑ Private Depth to Water-Table -------- ft. r, Character of soil to a depth of 3 feet. Sand Ej Gravel ❑ Sandy Loam /Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous A lication Made: Yes No PP ❑ LJ New Construction.-Yes ❑ No-❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptip T k Distance from nearest well..................Distance from foundation__---.._.--...._--_.Material-...._.-....------------------------------------ --------- .....-....--._. % No. of compartments--------------!" ::Size---- .._ -=-� Liquid depth Capacity - ------ f�., � p tY- ----� Disposal Fields Distance from nearest well-CPU....:"Distance from'founclatio {{ r r jj , -_-.y..... istance to nearest lot line_. :__---_ Number of lines-_-._..---lx�_Y.l--_---__- 'Length of each line--------- - �} rf - �=� Width of french--_--... Type of filter materi (17 t Yp = _ epth of filter material Y Total length -..-----•-- • q Seepage Pit: Distance to" nearest well-_-------------------Distance from foundation------------------------Distance to nearest lot line------------------ ` Jt ❑ Number of pits----------------------Lining material--------- ------------Size. Diameter-----------------------Depth------ ------------------------ tdn Cesspool: Distance from nearest well-...__.- 'i Distance from foundation.._- Size: Diameter-.....--------------------------------- ,. ----Lining Lining material..__-....,............................ ❑ i' .. .. u ---- ------ --.,Depth-------- ---- --- -------- -----Liquid Capacity- -------- ---------.gals. Privy: Distance from nearest well_"..__.-..-._ Distance from nearest building ❑, .. - Distance to nearest lot line.-------- 4- ------------------------------------------------------------•--------------- Remodeling and/or repairing (describe):-____.--"- --------------- __ 1 --------------------------------------------------------------------------= --------------- •------------------------------- -=--------------------•----------------------------:------------------ '------------------------------ ----------------------------------------- ------------ I hereby certify +hat I have prepared this appl' ation and,that the work will be done in accordance with San Joaquin County ordinances, StSte ws, and rules and re ulatio oft San Joaquin Local Health District. (Signed) -- t {Owner and/or Contractor) By:-------------------------------------------------•'------------------------ ------------------------------(Title)-------------------------=-------------------- -------=--------- ., (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 APPLICATION ACCEPTED -------------------------------------------------------------- ---------------------------- €' --- DATE ._ •---------------------- -- REVIEWED BY --------•---�- --•-----� ------------ ------------------------------------------------------ DATE---- ----•---•---------�•-----------••------------ Alteraat ons and/orTrecommiendations��:--_------- ----- ---- ------------ --------------------------•------------------------------- DATE ._..---.I_..--------------------------------- Wi ._-- ..._..------'_-... .r 1 . FINAL INSPECTION BY:-------,, -- 'L Date.' SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 Revised W-2100 #