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APPLICATION FOR SANITATION PERMIT Permit No. 6__ • __ (Complete in Duplicate) K-,;.Da fe Issued pplication is hereby made to the San Joaquin Local Hp-dIth District for a-permit to construct and install the work herein described. Tis. application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION. `�' `7 -------G�.a-. -''EI ---------------------------------------:-- Owner's Name___________________ " ° �4 Phone--.. � Address---------------_------------------------------- _0-_12e Contractor's Name_--------------------- _i . " --- �':� - `�� 11 Phone_. Installation will serve: Residence ,D. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I__-- Number of bedrooms An—Number of baths _1____ Lot size __4_o_- x-__�'_ ___E_ ----------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table _4/nft.p_� ` Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay ❑ Ad ,obeHardpan ❑ Previous Application Made: Yes E] No 'r; New Construction: Yes E] No ❑ 1.�� TYPE OF INSTALLATION AND SPECIFICATIONS: kkY (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 111L IY ep'tic Ta k: Distance from nearest well________________Distance from foundation--------.------------Maferial.-------------------------------------_------------ --si-� No. of compartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity--------------------- n%Q%� „DiF--t I Fi Id; Distance from nearest well----_-----_-----Distance from foundation--------------------Distance to nearest lot line_-___._- =____- ilF ff`' Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material-------------------------Dept i..er vial-------------------_--Total length-----------_--------------_--------------_ page Pit: Distance to neare well--�1-r ___Dista e f om oun atio !_______________Distance to nearest Ioline___�--__--- t,r ee Numljer of pits---- ---------------Lining mater l-__� Size: ameter------ Depth_ -- ----.-------__-•• Cesspool: Distance from nearest well-----------------Dis nce from foundation_ ------------------Lining material__--------------___________-_________- t❑ Size: Diameter--------------------------------------Dep -----------___-.- ------------- ----- --------------Liquid Capacity--------------------- -gals. Privy: Distance from nearest well___________________________________ ___________ istance from nearest building------------------------------------------ 1 ❑ Distance to nearest lot line----------------------------------- Remodelingand/or repairing (describe):------- --------------------•-------------------- --------- --------------------------------- ----•-•------------------------------------------------ __q i ---------------•-------------------•-•-------------------•-- ---------•--•-------------------•-------------------------•---------------------------------------------------------- •---------------------------------------- ,, 1 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. (Signed).1 a A 1.�' r ^~—� 'a x '�-------- - - --------------------------------!�end . Contractor) �Y :y; j -------------------------------------------- --- -( ----------------------------------------------------(Title)---t"`-`--S- _t__Y Y'� -C�-1 �f (Plot pla�,ing-size-of-lot, location of system in V lion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT SE ONLY APPLICATION ACCEPTED BY- , .� 'rf -- -------------- DATE----- -- REVIEWEDBY------------------------ -------------------------------------------- DATE--------------------------------- BUILDING PERMIT ISSUED--------------------------•-------------•------------------------------------------------------------ DATE - Alterationsand/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- ------------------------------------------------------------ --------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------------•--------------------------- ------------------•---------------------------------------------------------------•--------------------------------------- FINAL INSPECTION BY___ _ - _--- --_- Date. ''^_ / __ 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 8-51 Revised W-2100