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APPLICATION FOR SANITATION PERMIT Permit No. --L. . ..... (Complete in Duplicate) I I Date Issued ----- ---Z_4,4� A A_ pliceion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, JOB ADDRESS AND -tOCATION--------- 7 =7 ---7-------- A/ Owner's Name__-_____ 1 %-7> :X�_ - ----------•------•---- -------------------------------------------------------------- Phone----------------------- Address...................... ----4-V.... ............ 0-1a -- - C_ -/L/ > ----------------*------------------------------------------------------------------- Contractor's Name------ -2 --a-------------------------------------------------- -------------- Phone./P. Installation will serve: -Residence Apartment House E] Commercial E] Trailer Court [] Motel El Other F1 Number of living units: _j--- Number of bedrooms Number of baths ___/___ Lot sizeI ----------------------------- Wafer Supply: "Public'system El ' Community system E] Private 0 Depth to Water Table _!!! ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay El Adobe 0\ Hardpan E] Previous Application Made: Yes E] No Uj_ New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank,, "Dis"tance from-nearest well------------------Distance from foundation--------------------Material---------- e_— -T,1 -------------------------------------- El 4;e� `4Moelof compartments--------------------------Size------------------- ------------Liquid depth---------- ---------------�Capa�cify---------------------- Disposal .61d: ance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line______--______ e- EEII m p -pr of lines-_____-_----------- ----------------Length of each line------------------------------Width of french--------------------- I ------------- Typ(V' oT' filter material-------------------------Depth of filter material-----------------------Total length----------------------------------------- Seepage Pit: Distance to nearest-wek--- from foundafion---- _Distance to nearest lot lin e__ Number of pits-------/-----------Lining material--- Eq 6—f".�/e- Diamefeir----_-fr-5;.......Depfn----- Cesspool: Distance from nearest well-----------------Distance from foundation----- --------------Lining material_-_---____________-__--________Size: Diameter--------I---- ---------------- --------Depth---------------------------------- -----------------Liquid Capacity _, ---6---------1__�---------------gals. Privy: Distance from nearest well-________________________________._______I-__--Distance from nearest building_____-___----_______-.------------------- X 0 Distance to nearest lot line-------------------- _j Remodeling and/or repairing (describe);------------------------------------------------------------------------------------------------ _-7----------------------I-----------------------------------•-------------•-------------------------------------*------------------------*---------------------- ----- ------------ ----------------------------------------------I------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------------I----------------------------------------------------:--------I------------------------------------------------------------------------------------------------------------------- ----------- - I hereby-certify that I.have prepared this application and that the work will be done in accordance with San-Joaquin County ordinances, State—l-aws; and rulesandregulations of the San Joaquin Local Health District. (Signed)........ -------------------------- --------------------------------------------------------- wrier and/or Contractor) B) ---,4----—---- ---------4 - ------------------------------------ ------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------------B--Y---------------------- --------------------------------- DATE------------- --- A6 -- � - --- --------- REVIEWED BY ------- --------------------------------------------- DATE ----.---------..------------ -B-UILDING PERMIT----I-S--S-L-U---E--D--------------------------------------------------------------------------------------- -----------------------D— DATE.- - -------------------------------------------------------------------- -------------- A lterations and/or recommendations:-- -- ---------------- -------------- ------------------------ --- --------- ----- 2r------------ ------------------------------I------------------1.................I--------------- --------------------------------I---------------------------;---------------- --------------------- ------------------- -- --------------------------- ---------------------------------------------------------------------- ---------------------------------- -------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL 'INSPECTION-BY:- By)? w -------------- - -------------------- Date----------- -//__ -- 5, cr ----- ----- - 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 Revised W-2100