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[�` r APPLICATION FOR SANITATION PERMIT Permit No.(:13 D_ . 5 (Complete in Duplicate) Date Issued*A_1S"`_Y Application is hereby made to the San Joaquin Local Health District for a permit to co/rund install the work herein described. This application is made in compliance with County Ordinance N 549. JOB ADDRESS AND LOCATION_ __ J_�L-____ - - ----- ---------- ------------ --------------------------------------------- Owner's Name--- ��'-------------------------------------------- Phone_40` ,� _A-- - ------ - - ---- ----- ------------- -------------- ------------ Contractor's Name ------------ - 1----`-"-�-� Phone --- O Installation will serve: Residence X Apartment House ❑/Number ommercial ❑ Trailer Court I] Motel r` ❑ Other ❑ Number of living units: ---/_ Number of bedrooms -_-- _- of baths __/-- Lot size --____ r Water Supply: Public system )( Community system 0 Private E-] Depthto Water Table�Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] AdobeJ4 Hardpan ❑ Previous Application Made: Yes ❑ No V. New Construction.- Yes ❑ No ❑ Dew TYPE OF INSTALLATION AND SPECIFICATIONS: C� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance'from foundation--------------------Maferial--_.--____-__-_-__----___-_-__----___---____-_. ❑ No. of compartments--------------------------Size-------------------------------- Liquid depth------- ---------- ---CapacitY----------------------- Disposal Field: Distance from nearest yell------------------Distance from foundation---------------------Distance to nearest lot line--__----____--_-- V� ❑ Number of lines-----------------------------------Length of each lin ------------------------------ of french Type of filter material------------------ -- Depth of filter material------ Total length------------------------------------.---- 1 Seepa a Pit: Distance to nearest well/i -_Distant fo dation__ I� <�-8_ -.Distance to nearest I t line_�Q_____-._ Number of its-:---_- ♦� eR 1 -p�. �� -Lining material _ .Size: Diameter Depth Q --- ------- _ •e Cesspool: Distance from nearest well---------------- Distance fr0m.fouri8ation__-.= ---_-_____.Lining material_---- __::_-_--- _-- El -------- 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):---------------------------------------------------- = q ----------------------------------------------------------------------•--------------------------------- --------------•---------------------------------------------------------------------------------------------- --------------- I 1 -----•--------------------•---------------------------------- ------------------q---------------------------------------------------------•-------------•--•---------------------------------- I hereby certify A ve prepared this ap ication a that the work will be done-in accordance with San Joaquin County ordinanc s, S to s, nd ru s and regulation f the S oa uin Local Health District. (Signed_ } """^ ------ it Cwne Contractor) (Q C� { By:. *" -----------(Ti+e} t4/------ P of plait, sho g size of lot, location of s+em in relation to wells, buildings, etc., can be plied on reverse side}. r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-=-- ------ ----------------- ------ TDATE REVIEWED BY41 1 TE---- ---- ------- ------------------- -- ------------------------ IDING PERMIT ISSUED---------------------------------------------------------------- --------------------- DATE----- Alterations and/or recommendations:--------- -- --------------- -- - - 4. ------- ------------------ -------- --------------------------------------- " - ----------------------------- '----------------------------------- ----------------------- FINAL INSPECTION BY:------ ---------------------- Date---------- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca,.California Tracy, California .ES-9-2M 8-51 Revised W-2100