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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) - � Date Issued 6__�_d��-�• Application is hereby`made to the San Joaquin Local Health District for a it to construct and 4' This application'is made in com IianceTwith County Ordinance No. 549. perminstall the work herein described. 1101?e_ JOB ADDRESS AN �-CATION__ � � ��`" ""'" --_- ---- - bIfo-r z- % t p c-5- Owner's Name:� ---- •--- •- -- �_ ,- - ---- -- - -- --------- = l Address___ - � hone �Contractor's Name____________________ � •--------- -------------- -------_------- --------------------------------------------------------------- Phone--------------- lnsfallatioin ------------ - - ---------- Pane----------------Ins+alllatioa will serve: Residence ❑ Apartment House ❑ -Commercial ❑ Trailer Court ❑=> Motel ❑ ~Other~ Number of living units: ,___ Number of bedrooms _Number of baths __,/__ Lot size ------- Water -'Q-�----- ---�-�----------------- Water Supply: Public system ❑ Community system ❑ Private n Depth to Water Table _/0-_ ft, 3 Character of soil to a depth of 3 feet: Sand ❑ . Gravel ❑ Sandy Loam 4 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ rr'3 Previous-Application Made: Yes [] No New Construction: Yes ❑ NoI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pel—imr iffed if public sewer,is available within 200 feet.) Septic Tank: , Distance from nearest well_____P`d5___Distance from foundation__-____ __-_ _ �.' � Q____.Material-----�_ - __---- No. of compartments-----------�----------Size---- Liquid depth---------q'--------------Capacity---� E�" Disposal Field- Distance from nearest well-----rj__G?---Distance from foundation___.30-------Distance to nearest lorline..__ .-.- I� Number of lines------------------ r _ _Length of each line--------)4-_!5 ---------Width of trench----,?--�--�------------- y`�j' Type of filter material__ X'X 4_ - from foundation-------------------- to nearest lot line_______________- ❑ Number of pits----------------------Lining material----------------------Size: Diameter-----------------------Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________Lining material----------------------------.-------- . . .: ❑ Size: Diameter - Depth -------------------:---------------Liquid Capacity------------------- --gals. Privy: a 'Distance from nearest 11 - - Distance from nearest ui ing______ _____ w ❑ Distance to nearest lot line # 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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_____ --- (Owner and/or Contractor) sY- -- Title 1----- - --- - - - - •--- -------------------- (Plot plan, showing size of lot, loco+iori of system in relation to wells, buildings, efc., can be placed on reverse side). f AOR DEPARTMENT USE ONLY ,- APPLICATION ACCEPTED BY----------- ------ ------------------------------------------------------------- � ---------- DATE--------- -- ---------`---- ------ - ------•-------- WED BY--------IS I -- DATE------------------------------------------------------ -------------------------- ----------- v �--- --------- ------------- --•fix,./.,.BU�ILDING_PERMJT�ISSl1ED -_•--.�-_---------••------- -------------------------------------------------------------- DATE ----------•------------ -�_ --------- -•--- ------------ ----- ------------------------------------------------------------------------------------------------ Date. FINAL INSPECTION BY--------------------------- ----- - _ i - / 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-9-21A 8-51 Revised W-2100