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APPLICATION FOR SANITATION PERMIT Permit No. _.. 3 ------- (Complete in Duplicate) Date Issued" ---------- Application v- Application 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 LOCATION--------------- � �� + p Phone_1G� Q Owner's Name--------------------------- r �T- tF ---------------- - Address-------•--------------- ----------------------------------- - -- Contractor's Name-------------------- -- � •( _ .� f`�' '�'8.5 '-- .t�S, Phone =�rb_ Installation will serve: Residence 0( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f i Number of living units: ___I-- Number of bedrooms ._"V_ Number of baths __/___ Lot size __s�0---- �------- ---• ---------- Water Supply: Public system Community system El Private El' Depth to Water Table _oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeja Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ �p� G, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) tic Ta :f Distance from nearest well___________----_Distance from foundation-------------------Material--------------------------------------- _-_____.- No. of compartments--------------------------Size------------------------ Liquid depth Capacity C� posal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_________________ � — Number of lines-----------------------------------Length of each line------------------------------Width of - ._ french----------------,----------�-------_-_ - TYpe of filter material------ of filter material--------____________-_Total length---------------------------------------0.Seepage Pit: Distance to nearest well_ �2N�_ D efro on_1AA_._______.Distance to nearest lot line_________________ lm SNumber of pits--- Diameter---„4_3"------.Depth----��-------------- _____-- ___________ . rooion----_____-_-__-_--_.Lining material_______-__--_____ Cesspool: Distance from nearest well_________________Distanc k..C 171 Size: Diameter--------------------------------------Depth-7--------------- ---------------Liquid Ca aci gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building________________------------------------. ❑ Distance to nearest lot kne--------------- ----- ---------------------------------- -------------------------------------------------------------------------------------- i Remode4ing and/or repairing (describe):------------------- --------------•---------------------------------------. - - ---------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,Parules and reguI f, ns of the S Joauin Local Health District. //��. er Contractor) (Signed)------/_1!._. -a z. BY= Ln^� = -- ------------ - ----- ---- (Title)- - - - --- ---------------------------------- -- (Plot plan, jwing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY - -- DATE----------: _ APPLICATION ACCEPTED BY-------------------------------- S ----5------- -2--�! � BATE REVIEWEDBY------------------------------------------------------------- - ----- -------------------------- ----------- -- BUILDING PERMIT ISSUED------------------------------ DATE Alterations and/or recommendations:----------------------------- -----------------------•----------•-------------------------•------------------ ---------------------------- h ----------------------------------------------------------•--------------- ---------------- FINAL INSPECTION BY L/_ --------------------------- ------ Date- --- - -----------------•-----,------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street Soo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M B-51 Raised W-2100