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N �APPLICATION' FOR SANITATION PERMIT - �--�P�rmit No.�----------••------ a ' (Complete in Duplicate) 9 I' ® s Date Issued �1 6---•----:----�-_----- App Ica Eon Is ereby made to the San Joaquin Local Health District for a permit to c nstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549. --------------------------- JOB ADDRESS AND LOCATION_____ � 5--, -_•_-_- _ w f Owner's Name__.-•-------- ------ � --/ '- � -' -------------------------------------------- Phone =„: Address----------------•-------k- --.-- .0,411 Contractor's Name -_ -------------- Phone----------------------------------- --------------------------------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E❑ Number of living units: ______ Number of bedrooms .l---- Number of baths I___ Lot size ---------7`1�K � !g '/ ------ Wafer Supply: Public system ❑' Community system '❑ Private X Depth to Water Table T�ft. Character of soil to-a depfh'of 3 feet: Sand ❑ Grave! ❑ Sandy Loam E❑ Clay Loam ❑ Clay E] Adobe a Hardpan ❑ Previous Application Made: Yes fflf #No [9 New Construction: Yes No ❑ - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic Tank: Distance from nearest well__- �-----Distance from foundation-------/d_t_ -.Material.-____91 _____ ) No. of comP artments----------9- -- --------Size----u_ -!�--X- ---Liquid depth--------.`'�-- -��---Capacity ---- 'bC�---- I Disposynl Field: Distance from nearest well-__-- ---Distance from foundation ._1D_� Distance to nearest lot line--------6--/_- ANumber of lines__r_________-�________ Length of each line-----------/OU 62,1 -Width of french--------------- I �---------_- Type of filter material--/ _f __ Depth of filter material______! .__Total, length___ spa ! - 2-•-- Seepage Pit: Distance to nearest well----------------------Distance from foundation----------.---------Distance to nearest lot line----------------- El Number of.pits---------------------Lining material-- ------.Size: Diameter----------------------Depth--------------------------------- f A Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________-_______________.------------- ----------------------- ___.__.____. {FY' ❑ Size: Diameter---------------------------------------Depth------------- ---- - ---- ---- ---- --Liquid Capacity---- --gals. .. . -. -= gin - - Privy: Distance from nearest well __ __ ___ __________________ _____ _Distance fro' neaeest"buildin 5=---------• --' --------------- ❑ Distance to nearest lot line---------- ---------------------------------- Remodeling and/or repairing (describe)______________________________ t ------------------------------ -------•-•--------------•--------•--------•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, Sfafe s, and rules qp reaulatio s of the San Joaquin Local Health District. ,- (Signed-.- s ------- -- - ------ -- ---- O d ---- - ------- B � � ___ caner and/or Contractor) ---------------------- ------- -- Title ----- - --------------------------------- ----- p (Plot plan, showing size of lot, location`of system in r anon to wells buildings, etc, can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY REVIEWEDBY ---------- . ----------------------------------- DATE------------------ ------------------------------------------- BUILDING ----------- - ----------------------- - DATE--- -------------------------------------------------------------------- BUILDING PERMIT ISSUED ------------ - -- ----------- - DATE ---------`------------------------- --------- ------ - ---------------------------------------- DATE-- - & Alterations and/or recGnimendations: _._ 111 s .Y------------- - ------- ------------------------- ------------------------------ ------------------ ------------- ------- ----- s ~ ---- -------------- ------------------------------------------------------- -- -- FINAL INSPECTION BY:__:-___. - -._ f4 ti -----` Dare - 1 �/ 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