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APPLICATION FOR SANITATION PERMIT Permit No. .___�� --•---- (Complete in Duplicate) 6 _ Application is a by made to tDate Issued he San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordnance mance No. 549. JOB ADDRESS,A D LOCATION_.- '" ----- --- •---------------•------------ Owner's Name-----------------•--�,,;•- •- - ------------------ Phone ------------------------------ Address......... ---------- - -- ------ on Tactors Name___ ____________ _ __• ------------- -� ---•- •-------- Phone----------------------------------- Installation will serve: Residence Apartmenfi House Commercial [I Trailer Court Number of bedrooms - E] Motel❑ Other Number of living units: N ❑ --- _ Number aths ---/-- Lot size ---.-��e,� Q � Water Supply: Publics stem --- Y Community system ❑a Private. Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand (] Gravel [ Sandy Loam ❑ Cla Loam Previous Application Made: Yes ❑ }No EJ New Construction. Yes ❑ No E] y ❑ Clay ❑ Adobe❑ Hardpan [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi cATank: Distance from nearest well No. from foundation--------------------Material___________--_----.- No. of compartments Size = W f�' Liquid dept Capacity f s o al i ,d: Distance from nearest w,ellJ-0.0----_Distance from foundatio �' �tif/ umber of lines____-______- Distance to nearest lot lie - - - --- Length of each line-___-_- --- !j---•-----•-- 2 ype of filter materia _ i9p ri --Width of trench____- -2i ' epth of filter material-------�(___ --------Total length------- __ Seepage Pit: Distance to nearest well--------- ---- /- - --- istance from foundafiion___________________.Distance to nearest lot line______________.__ ❑ Number of pits____k____--_-_-__-_Lining material______--_ '�' • ----------Size: Diameter----------------------Depth----- ------- -------- Cesspool: Distance from nearest well-----------------Distance from foundation_-..____-------_--Lining material---______-_____._-_-____-_-______--- ❑ Size: Diameter----- `----------------------- ------ Depth-------------------------------------- Liquid CapadtY-------------------- Privy: Distance from nearest yell_______________--__- ------ gals. ----------------------------Distance from nearest buildin ❑ Distance to nearest lot line---------------- 9 ------------- Remodeling and/or repairing (describe)______________________ ' ---- -----•-------•------•---------------- ---------------- -------------•---------------- ----- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Jaayuin County --- ------------- or finances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)__ -_.- --------------------------------------------------- and/or Contractor) - ---------------(Title)------------- Plot plan. showing size of lot, location of sys+em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY g� -------=------------------- ------------------------------------------------- REVIEWED BY DATE_--�•------------------- BUILDING PERMIT ISSUED r-a�----------------•-:------------------•------ Alterations and/or recommendations: yl 1y DATE.._.___ftt� '.i-- _!��s --. _ ------------------ -------------•-�-------- ------------------------------------ - --- ----------------- .- _ Y{1_Yr�.--1 -� SC. s�Y�.__ r.E^cYj= Leei P j (r 1 _ __ r-----------[ c Tti p� . . /__.._ c�-r1.`_ ------------------------------------ 01f, .- ----------- '"FINAL INSPECTION BY:.._- > ---- Date - � ---------- ------------------ S, J�y �Y1 a SYc Street Stockton, California Lodi, Cali rnie 8�-rrC�al C" Street ,=r: teca, e' rtce ifo is ES-9-2M I0-52 Revised W-2100