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- y APPLICATION FOR SANITATION PERMIT Emit No. (Complete in Duplicate) O�� (/ Date Issued _-- ----_�__.� - Application is hereby madeto the San Joaquin Local'Health District for a permit to construct and install the work herein describell �- This application is made in compliance with County Ordinance No 49. JOB ADDRESS AND LOCATION--_, .a - - . .7 ✓ Phone.. Owner's Name-- - ---•-- -- ----•- - - - Address-------------------------- . z. rr Contractor's Name------�_ .14! / - --------- ------ Phone. ..+I! ...... w . Installation will serve: Resi ence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other'Q Number of living units: __ ___ Number of bedrooms s - Number of b the .� X�_ --• Lot size .-Wfi- Character - .................. - Water Supply: Public system ❑ Community system ❑ Private epth to Water Table of soil to a depth of 3,feet: Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay E Adobe❑ Hardpan .Previous Application Made: Yes ❑' No ❑ New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: ('No septic tank or cesspool permitted'if public sewer is available within 200 feet.) F Septic- Tanjp. Distance from nearest wellQDistance fro undation---,/ .....Ma i L_ No. of compartments---- 4' p .�=--------------Size---. Li uid depth--9 ..� qP Y Disposal F d: Distance from nearer ell--&__- __. Distance to nearer# o �e „ p !J_ istance from foundatio ,�. _ Number of lines-•_�__ ength of each line.__/'� Width of trench-_-_ __----- .. Type of filter material--� !0 _ Depth Of filter material__I_-�---------Total length-- --------------f-. . ._ Seepage Pit: Distance to nearest well._ ___-_____-_-Distance from foundation------------- ----.Distance 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......... g Privy: Distance from nearest well_________ __________ _________ ---------Distance from nearest building........................................ x Distance to nearest lot line____-__-----••_-_ 5 '' f --- -- --- •--•- --- -- --------- -- --••••---•----•-- Remodeling and/or repairing (describe)-------- --------- - --.. -----• ................................._. ................ ------ -------- -- -------- ---- -------- ----------- --- -------- --------- --- --- ------------------- . --...-------- ------. . • -•-••-. -----•. ---• •--• ------ ------- ---••=- ---•-•..L------------------------------------------------------ -- ------------------- -- ---- --------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance wii#h San Joaquin Coun9 :'' ordinances, State laws, and and gulat' ns o the Joaquin cal Health'Distri : ' Sined ( .g ) s '._. (O r andJ r Contract BY -- ------------- ---(Title} �$ (Plot plan, showing size of lot, location of system in relation to wells, buildings, eta, can be placed on reverse side). FOR DEPARTMENT USE ONLY 0. APPLICATION ACCEPTED' BY ------- - - DATE. £ REVIEWED BY � ---------------------------------- ------ ------ ---- --- DATE . ...--•---•---•• - - -------- ------ ------- BUILDING PERMIT ISSUED..-__ .---- DATE - ' Alterations and/or recommendations---------------------------------------------- --••...----------------------- ---------------------- -• --.•--- .......................................................... - ' " j. -- - - --- -------- - ----- -------- -.---- ----- -------- ------ -- ------------------- ------ !/ ------------ 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