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I' APPLICATION FOR SANITATION PERMIT Permit No.,:�,?_..6.-_ _ _ ----- (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 compliance with County Ordinance No. 549. ;1flti1. -9: � S7_ • 1 JOB ADDRESS AND LOCATION_____ "--------------------------- Owner's Name •--------------------- - ~- "` c "'=-4=----------------- --------------------------------------- Address----------------- -------------Address-------------------•-_--------------------- �..e...,_� Contractor's Name------------•---------- - --- ---------------- ��.._ Phone------ Installation will serve: Residencely -Apartment-House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___ Number of bedrooms _ Number..of"baths ..-f•_ Lot size --------- --rX--/_h-c� _ -------------- Water Supply: Public system �K_ Community system ❑'• Private❑ Depth to Water Table 44:� t. P m Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IML Hardpan ❑ r Previous Application Made: Yes ❑ Nojg, New Construction: Yes No �` x TYPE OF INSTALLATION AND SPECIFICATIONS: l P (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y �, pis Ta k: Distance' from nearest well------:----------Distance from foundation----------- _______,fir____.. Maferial___s._:_' .. No. of compartments______ :Size_____..t_- -------------- Liquid-.depth---`------------ ---------Capacity----------- ,. . _. Disposal Field: Distance from nearest well__.__'",.____Distance from,foundation_____________i-----Distance to nearest lot line______________-- �1 Number of lines-----------------------------------Length of each line-------I-------------------_.Width':of trench--------------------------------•-- N Type of filter material------------------ -----Depth of filter material--------------------_"_Total•°length-------- ---------------------------- •--•-- Seepa e Pit: , Distance to nearest well _ -----------------Distance-frfoundation_______�,._..__._. DLstance to nearest lot line___ ' Number of pits__.___/___.------__Lining material___________-_____ Size:`Diameter___- . _._ f` .� Depth ------------------------ ------ Cesspool:— ,,,,,Distance from nearest well----------_------Distan a from foundation-----_------------..Lining material-41------------------------------------ ❑ SizeWDiameter--------------------------------------Depth-- x-•-------------•-------------- ------Liquid Capacity- -------gals. `�•� Privy: Distance from nearest well--------------------------------1---------------Distance from nearest bui#ding ❑ . Distance to nearest lot line------------------------------------------------•-----_-_--- ------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------------- •-- w ' ---------- ----------------------------------------- --------------------------------- ------ - --•---------------------------------------------•--------------------------------------------•--------------------------------- ------------------- -------------------------------•--------=--------------•-•--------------------•----------------------------------------•-------------•---------------------•----------------------- ----------- -------------------------- ------•--------------•---•-------------------•--•----------------•----------------------------------------•-------------------------------------- -----= I' hereby certify that have prepared +his1application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and,regulafions of the San .Joaqu;n Local Health District. (Signed) �- ------------------------------------- - ------ --�'---_ -(4D"er^and/br-Con+raefor) -- ------------------------ (Plot Ian, showing of lot, location of system -- relatioy�� (Title)____ ? 'ff �► '" p g y �l+o wells,.buildings, fc., can be placed on:reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY� - ----- --------------- --------------- ---=------------------------------- ------ DATE-- : ------------ REVIEWED BY----------------------------- -- --------------------------------------------------------------------------------- DATE-----= BUILDING PERMIT ISSUED------- DATE. $r� ------------- Aiterafions and/or recommendations:_------ ----------------------------------------------------------------------------•-----------•---------------------------------- -------------------------- --•--------------------------- -•-------------------------------------------------------------------------------------------------------------------------------------------------------- - ---------- ----- --------------------------------- (f FINAL INSPECTION BY--------------- - ---�-- - �---�(-.-. -�-- Date----------�' _j �/`5� --------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 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 10-52 Revised W-2100