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Permit No. �--3•!--•�-•• APPLICATION FOR SANITATION PERMIT 9 GDate Issued -- �� lr � (Complete in Duplicate) i hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is y This application is made in compliance with County rdinance_ No. 5 � 9 -----Y3.a----- -------------------'�"-= --------------------------------•- JOB ADDRESS AND LOCATION.__.__-o-9 ! j j-� ` �-�/� Q--• -�2_�.o--------------------------------------------------------------------------- ------- X2.5----------- Phone Owner's Name-------------------------------------- :J � Phone------ 490 Contractor's Name------- sk-------- ------ ----- Address -----------------•------•- f- R Motel Other ❑ I Apartment House ❑ Commercial ❑ Trailer Court ❑ Installation will serve: Residence [ Apn� f-Q-�_________________ i Number of living units: 1----- Number of bedrooms std-. Number of baths -_�--- Lot size ' _`_° ft. + Private E] Depth to Water Table Water Supply: Public system Community system [ICla Lam El Clay E] AdobeK Hardpan ❑ Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ y Previous Application Made: Yes ❑ NoA_ New Construction: Yes ❑ No F TYPEO IN AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material a Distance from nearest well___-______-___--Distance from foundation_________________ Capacity Size--------------------'------- Liquid depth--------- ------ ---- p Y No. of compartments-____.--- --- - __ _ i i } 'old: Distance from nearest well------------------------- - penath ofre each linea#ion--------------------.Width ofttre Ghest lot line----------------------------------- Or -- _-----.--• i Number of lines----------------------- 9 Total length -------- ----•------------- De th of filter ma#erial---------- ------------ g i Type of filter material___________________ p k Distance to nearest lot line__ _______---_ Dept ------------------ R. ----------------- See age Pit: Distance to nearest wellQl�_lR-_----Distance from founds zie np ameter_- _ _ _-__. p Linin material I Number of pits_--I----------------- g Distance from nearest well-----------------Distance from foundation------------------ materia4_-___...._-_______-.--------.=------ I Cesspool: _Li Liquid Capacity----------------------------gals. f Size: Diameter--------------------- ------ ------- Depth----------------- ------------- ------- ------ -- q ----------------------- _ I Distance from nearest building Privy: Distance from nearest well----------------------------------------------- __._---------------- - - - ------ -------------- ------ ----------- - - ❑ Distance to neares# lot line------------------------------------------------------- Distance ----------------------------- - - ---------------------------------------------------------------------------------•--- Remodeling and/or repairing (describe =------------- ----------------------- --------------------------- ------------------ ------------------------------ epared this application and that the work will be done in accordance with San Joaquin County ordinances, S at aws, a rules in regulations of the San Joaquin Local Health District. act antr or (Signed)-------- -------(Title)- '4`x�`c� -- -----;&qB y---------------------------------- - , etc., can be l ce on reverse side). (Plot plan, showing sire of lot, Location of system in rela n to wells, buildin P FOR DEPARTMENT USE ONLY DATE --------------- ------- ------------------------- APPLICATION ACCEPTED BY---- ------------ DATE__ REVIEWEDBY---------------------------- DATE--------- A------------------.-------- -------- •-------- ------------------------------------ ----------------------- BUILDING PERMIT ISSUED-------------- ---- --------------- Alterations and/or recommendations--------------- --- - - __.---...--------.------------ ---------------------------------------------------------- ----------•------------------------------- --------- ---------------- -- ------ Date--.--.r ------------------------------------------------- FINAL INSPECTION BY:-._ ----��---- - =-- --- --�----- SAN JOAQULN LOCAL HEALTH DISTRICT gl4 North "C" S+tact 30D West Oak Street 132 Sycamore Street 130 South American Street Stockton, California Lodi, California Manteca, California Tracy, California + ES-9-2M 0-52 Revised W-2100