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APPLICATION FOR SANITATION PERMIT Permit No.1-3,-2.1_7... (Complete in Duplicate) �! 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 complia e with County Ordinance No. 549. .Z�te3�.4:S:.RCtf",�isnc4,v-�J JOB ADDRESS AND LOCATION-- __-_ Owner's Name----- - - ------------- -- ---- -- -- - --- ----- ------------------------------- -------------------------------------=----- Phone--------- Address--- Contractor's Name --------------- ------------------ Phone------------------------------ --- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [j Motel E] Other El Number of living units: -(------ Number of bedrooms VNumber of baths ----r-- Lot sizee_ _ f4t _ -Water Supply: Public system E] Community system ElPrivate Depth to Water Table . Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam M Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 9�_ New Construction: Yes NN ❑ F A/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Ta ! Distance from nearest well---------------_Distance from foundation--.--_-_---_.____-.Material_-_-__--.-------------------------------- o. of compartments-------------------------Size---------------•----------------Liquid depth--------------------------Capacity----------------- 1131GO isposal Field-- Distance from nearest well_,-.Z -__Distance from foundation___Z"'Q---------Distance to nearest lot line-_�a_L?------ e Number of lines----I.__-____. __ Length of each line------�..,.5'-___--_--.Width of trench-__-_-__ q -------- ------------ Type of filter materiall.- ______--___Depth of filter material-----/--®------__-_Total length.------_'�IS100___ --------- age Pit: Distance to nearest well___;UT'0-----Distance from foundation_--/._�----.---.Distance to nearest lot line--_--0---_---- Number of pits---I----------------- % - ----- --------.Size: Diameter--------- - .--__Depth----a S�... Cesspool: Distance from nearest we!l----------------- an r foundation.-..--___-___.----.Lining material--------._--___-------__------______. - ❑ - - Size: Diameter------------------------------ -- D th --- ---- (quid Ca aci# _. �q R._....Y- ---------gals. _ y Privy: Distance from nearest well----------- -------------_-___.-------------Distance from nearest building �� i ❑ Distance to nearest lot line--------------------_--___-----__.-------_.____:- RR Remodeling and/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 1 ordinances, State laws, and ules and regula ions of the San Joaquin Local Health District. {Si ned g )•------------wl _ � �-�-- - ---- --------- ------------------_--------- --=----- -----------------------------------------Ukatokwo4or Contractor] By:------------------ ------------------------------------------ --- (Title 6a. (Plot plan, showing size of lot, location of syst relafion to wells, buildings, etc., can be placed on`geaesse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------------------------------------------------------------------------------- DATE r REVIEWED Y-------------------------------- - ----------------------- -------------- -------- ----------------------- ----- DATE---- •--------- l -------------- PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ----------------- BUILDING , --------- --- r Alterations and/or recommendations:------------------------- - ---- ------------------------------------------------------ --------------------------------------- - - 92--c-.1f--------- 1 --- ------------------------------------------------------•----------- •----------•---------------------------•----------------- a -------•------------------------------- -------------- ------------------------------------- ---------- ••---------------------- ----- - FINAL INSPECTION BY:----------------- ------- �.-_ Date -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 3 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street jl Stockton, California Lodi, California Manteca, California Tracy. California ES-9-2M Reviseci 1-57 F.RCO.