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� APPLICATION FOR SANITATION PERMIT '`� � Permit No. �_rl__�� • " U` .(Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health Distri t for a permit to construct and install the work herein described. This application is made in compliancewithCounty Ordinance No 549. �° r JOB ADDRESS AND LOCATION__ _�Z__ _ -- --- -----------Q--4_ Owner's Name st,----------- -- -- - ----------:-Phone-_97797,577 Address-------------------------------- ----------------- Contractor's Name----------------------- � /-� � Phone . -------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1_____ Number of bedrooms _Z/Number of baths _ ____ Lot size ------ T`-_lQ---__---------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table �ev ff. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes [❑ No 5 New Construction: YesA No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu lic s er is available within 200 feet.) __ . _ SeptTank: Distance from nearest well_ ____Distanceromli nd tion/� -------- Material---- p� _ No. of compartments------- ---------Size - - ---aC tViquid depth--- -"_-------Capacity-- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line---------------- ❑ Number of lines-----------------------------------Length of each line-----_------------------------Width of french Type of fitter material--------- ---------- ---Depth of filter material-----------------------Total length------------------------------ Seepage Pit: Distance to nearest well ---Distant f fau ation__I _�_____.Di tante to nearest lat line --__- Number of pits-------/------------lining materia______ ___-G-_ Size: Diameter_- - -�j---Depth._.;?.T'---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_____-___---__------_____________- ❑ Size: Diameter________________________ -----------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest buildin ❑ Distance to rearest lot line-------------- - Remodeling and/or repairing (describe):-------------------------------- ------------•----------------------------- - -----------•------------------------------------------------------•------------------- --------------------- --------------------------- ------- --------------------------------------------------------------------- -----------------------------------------------------------------------------•---• ---------------------------------------------------------------•------------------------------------- ----------------------------------- ------------------------------------- ----- ------------------------------------------- -----------------------------------------------------------------------------------------------•---------------------------------- I hereby certify +h have prepared + s application and that the work will be done in accordance with San Joaquin County ordinances, State law a rules and reg a ions of th San Joaquin Local. Health District. (Signed) � ��[- r_..- - ------------------------------------------------- Contractor) SY� -- -----------------------------------------------------------------------------------(Tife)-- --------------------- (Pio+ plan, h Ing size of Ivt, Io,ati n of system in relation to wells, buildings, etc., can be lazed on revers 9 p e side). FOR DEPARTMENT USE ONLY :.. APPLICATION ACCEPTED BY-----------------1 -_,�_ ------------------------------------------- DATE_ n -------------- REVIEWEDBY --------------------------------- =------------------------------------- bA7E I - --------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations: - -------•-------------------•-------------------------------- FINAL INSPECTION BY:_.---W V- � = Date � f j = ~- �. SAN JOAQUIN LOCAL.HEALTH DISTRICT 130 South American Stre& 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, CaliforniaTracy, California ES-9--2M 8-51 Revised W-2100