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-] APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate ..�� ,.� � Date Issued .___l!_�7�______ Applica4-ion 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 ANfl LOCATION_____ -- ------ -----------u___---_---- - -- 111 Owner's Name----- ----------------- Address----------------- •-------,---•Address----------------- --------------- Contractor's Name Q -----------------------------------•-----------• --------------••------ Phone _----`� a 7 Installation will serve: Residence Apartment House E] Commercial E] Trailer Court F1Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms _-A— Number of baths --- Lot size __-_02__ Water Supply: Public system ❑ Community system ❑ Private'�epth to:Water Table _ f. r . Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E],, Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [P"�Lw Construction: Yes ER"ONo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet j Septic Tank: Distance from nearest well__ ___Distance from fo ndation_----�-----.Material �_. ,__--- -_•- --_ IC _ ... // .� ap No. of compartments_-----p�______________Size�iQ� ��---�C�Liquid�/dap/h---_---��---------,Capacity--.�d0-___�__ Disposa field: Distance from nearest wail a6U�._.Distance from foundation------l.Q-------- Distance to nearest lot line.-J-d Number.of lines------------ -- - --_._-_ Length of each,line___,__s.3'Q.__ ------ Width of french.___v�1 ____.________-_____ f Type of filter mate rsal,lo__lr ----Depth th of filter material-____ _--.___I__-Total length______s-Q__________________--_-__ See a Pit: Distance to nearestwelL.__c _ Q_._� Distance fro fou dation------ a_____-Distance to nearest lot lire_- ______ Number of pits------[_________ Lining material_ _._."'fou __Size: Diameter___-�3__i------- ' ,a1. Cesspool: Distance from nearest well-----------------Distance from foundation---------------_._.Lining material ❑ P>. Size: Diameter---- ----------------------------- ----Depth----------------------------- ------------- - ------Liquid Capacity------------ = gals. Privy: Distance from nearest well-------------___------------------ ------------__Distance from nearest building_-_----______--_-___._ ❑ Distance to nearest lot line---------_----------------------------- ---------------------------------------------------------------------------------------= -------- Remodeling and/or repairing (describe)----------------------------`--------------------------_ - ----------------- •------------------------------------------------ ------------------ --------- ----- ---------------•----- -------•------------ - ------- --------------------------------------------------------- -•------•--------------•--•--------------- -----•-------------------------------------- ---------------=----------------------------------------------- 1 hereby certify.fhat I have prepared this application and that the work will be done in accordance with San Joaquin County ' ordinances, State laws and rules and regulatio of the San Joaquin Local Health District. F1� (Signed)---- - -- ---- MNmer and/or Contractor) By: t -- ------- ------------------------------------------- (Title).. - --- - (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 BY---- '_-. -- _ DATE------- ---- --•�--_----CS--- -"A-- = -- REVIEWEDBY ------------------------------p ------------------- DATE----------- -------•-- ------------ BUILDING PERMIT ISSUED--------------=----------------------------------------•-------------------------------------------- DATE Alterations and/or recommendations:----------------------------------------------- •---------------•--•---------- --------------------•-------------------•----•------ ---------------------------------------------------------------------------•--------•-••-----•------------------•••--------------•--------•- G FINAL INSPECTION11A---- --------------------------- Date `S f--- -------------------------------- SAN ---------------------- ' 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