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APPLICATION FOR SANITATION PERMIT Permit No- ---------- (Complete --------(Complete in Duplicate) Rg Date Issued l" Health District for a ermit to construct and install the work herein described. Applica{ian is hereby made to the San Joaquin Local permit This application.is'made in compliance with County Ordinance No. 5 49. JOB ADDRESS AND LOCATION------ ----- - ----------------------------------- Owner's Name :. .. # -, ------------------------------------ Address-------- `�° --- --•------ .__ Contractor s Name-.. = Installation will serve: Residence A artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ if w Number of living units: J--- Number of bedrooms ---17__--- Number of baths I--- Lot size ----_r7__'S-_--�/OA- --------------------------- Water Supply: Public'system �ommunity system [I Private E] Depth to Water Table _��t. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[! iardpan E] Previous Application Made:. Yes ❑ No R----New Construction: Yes ❑ No TYPE OF INSTALLATION AND-SPECIFICATIONS: (No sepfie,fank.or cesspool.permitted if public sewer is available within 200 feet.] �ep •c _ _ .Tank: Distance from nearest well-___------__ ---Distance from foundation--- ---------------Material----------_____---------------------------__----. gL t No. of compartments------ ---------------- --Size---------------- Liquid depth------.--------------------Capacity----------------------- Disposal'Field: Distance from nearest well_91'7"Distance from foundation_-./A----------Distance to nearest lot ------ Number of lines------1----_-- Length of each line-------o.-------------- ----Width of trench---- ---------------- Type of filter material_. --------------Depth of filter material---- - ----------Total length_-_.- --------•---_--_------- • Pit: . " 'Distance to nearest well -----Distance from foundation---"/d--._--_-.. s�n�e to nearest I line---�-s.... Number of pits-----1___----------Lining material_--.8 Size: Diameter-------_--__-..-----_-Depth----- ---�-.-_----___-------_�� Cesspool: Distance from nearest well-----------------Distance from foundation--._-------- �----.Lining material------------------------------------- ❑ Size: Diameter------ -----------------------------Depth------` ----------------------- ------ Liquid Capacity gals. Distance from nearest buildin Privy: Distance from nearest well-------------------------------f-------- f 9 ❑ Distance to nearest lot line------ -----=--- -----_-------- ---------- -------------------------=-------------------•------ t :3 Remodeling and/or repairing (describe)---------- ------------------•----------------------•-----------------------------------•--------•------------•---••-------•--------------------------•- 1 t ----------------------------- --------------------------• --•--------=------•-------•----•---------------- -- - --------------- T- --"-•------'- -- -- I hereby Certify that I have prepared this application and'fhat the work will be done in accordance with San Joaquin County ordinances,_Stafe laws, and rules and regulations of the San'rJoaquin Loc31 Healthy, District — � - (Ownef and/or Contractor) 9 Si ne a . , �Y= �`�` ------- -------------- (rifle) .�. (Plot plan, showing size of lot, location of system n relation to wells, buildings, efc.; can be placed on reverse side). i FOR DEPARTMENT USE ONLY 4 M s c -----------_--------------------- --------- DATE ��, APPLICATION ACCEPTED 13Y_ ---:--::----.----_------------- - REVIEWED BY --�=------------------------- DATE c f ----- --- -- ---------- - t �.. w, ..�_ _....., --------- DATE-------- -------------------- BUILDING PERMIT ISSUED------------------------- -- - ---------------------------------------------- ------------------------ -------------------- Alterations and/or recommendations:----I---------------------- -----•-•--------•--------••-----�•---------•-----�---- -------------•-•-••-------------------- I --••-•------ ----------------------------------- 1 µ------------- -------------- ---------------------------------------------- ------ -•-------- ------------------ ---------------------------------------------------------------- + --------•-----•-- -----•---•------------------•----------------------------•------------------ -- -----••-------- 44 FINAL INSPECTION BY:------ "------------------------ Date:. ----- --- •F- -'------------ ------------------- SAN.;JOAQU,IN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2 M Revised W-2100