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y APPLICATION FOR SANITATION PERMIT (Complete in-Duplicate) Permit No. 7 Date Issued This Application is hereby made to the San Joaquin Local Health District for a permit to c /TT f 3 application is made in compliance with County Ordinance No. 549. onstruct and install the work herein described. JOB ADDRESS AND LO TION___ Owner's Name ------- --- -- - - - - ------------------------------------------- ress--•----••--- -• - ..'-- _ ane ontractor's Name--.-- --_r t _ Installation will serve: Residence Apartment House --sr- - - Number of living units: . ❑ Commercial J] Trailer Court ❑ Motel g �___ Number of bedrooms -- __ d ❑ Other [] Water Supply: Public system �-- Number of baths ---/- Lot size __ - Y ❑ Community system �� --j-4 / ---------------- Character of soil to a depth of 3 feet: Sand ❑ Private X Depth to Water Table -_ ft. Previous Application Made: Yes ❑ Gravel ❑ Sandy Loam ❑ ClayLoam New ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: � Construction: Yes [] No [�' (No septic tank or cesspool permitted if public sewer is available within 200 feet. Septic Tank: ) p Distance from nearest well-----------------Distance from foundation_--_--_ _ ❑. No. of compartments----- -- - ----------.Material---- -------------------------------------------- - --- ---� ----Size--------------------------------Liquid depth--�------ �- r Distal f=ield: Distance from nearest well //�� -------------Capacity-__.--________ V._Distance from foundation-__.---�. Number of lines--------------- -_--Distance to nearest lo} line I� Lang}h of each line t/ Type of filter material-----`/ _ �- Width of trench.-__-_ ' ---------------- Depth of filter material----- length_-_--___,��' Seepage Pit: Distance to nearest well_ ________ _ Distance from foundation---- __- ----------- -- ❑ Number of pits----------------------Lining material- Size: Diameter_ .Distance to nearest lest lot line----------------- Cess ----------------- Cesspool: -- --- -----Depth--------------- ------ i p Distance from nearest weft _-___-__Distance from foundation--------------------Lining material __ Size: Diameter------- -- __-_ ------Depth--------------------------------------------- ------- -- ----------- Priv ----------- -- ----- -- --- - - - ------Liquid Capacity-- --------------- Distance ---------- - -'..R Y' Distance from nearest well----------------------------------------------- - --Distance from nearest buildin Distance to nearest lot line _ -------------------- Remodeling and/or repairing (describej----------------- -------------------- -- - ----•---- -----•----- --- ------------------------------------------------------------------------------------------------ I hereby certify, that I have prepared this application and that the work will be done in accordance with San Joa uin C ordinances, 5ta a laws, and rules and regulations of the San aquin Local ealth District. q ounty (signed)------ --- ----- � By:Y:•------•- (cam and/or Contractor (Plot plan, showing size of lot, location of system m - ----------------------(Title)_-- relation to wells, buildings, etc., can be placed on reverse side). --- --- --- - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- . REVIEWEDBY_-----...IS -- E --- -------- -- ------------------------------------------ ------------------- ------ DATE BUILDING PERMIT ISSUED____.--__- _ DATE--------- ---- - ------------------ -- - - Aterations and/or recommendations:___- ---------------------------- DATE---------- ------------- - ------------------- -----------•------------•- __ .-- ----------- - ---- -_ -_-__.._--__--------------•--`----------- FINAL INSPECTION BY________________ --- -- --� ---•--� -----------• Date----------------- - - -5;- ------ ----------------- 4 SAN JOAQUIN-LOCAL HEALTH DISTRICT 13D South American Street � 300 West Oak Street 132 Sycamore Street 814 North „C„ Lodi, California Manteca, California Street Stockton, California Tracy. California E$-9-2M 10-52 Revised W-2100