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J APPLICATION FOR SANITATION PERMIT ermit No. _ _ 9 - �. (A [Complete in Duplicate] � `� Date Issued 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'it F------- -c -------- .-------- ------------ ------------------------------ JOB ADDRESS AND L .CATION__ f� s �/� Owner's Name------------4AN------------ - iS,_.�r-1E`.G— ------------------------------------- J /, --------------- Phone---��-T-,741----- Address ----------- 4----------------------- --------- ----------------------------------------------------------•- ��0 y t Contractor's Name '--- -'---------- • ------ e------------ Phone--r'—"� 07----••- a Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court-E❑ Motel ❑ Other ❑ Number of living units: J_-__ Number of bedrooms I---- Number of baths Z____ Lot size _,s,- -9--- Water Supply: Public system Community system -E] Private E] Depth to Water Table !7 ft. Character of soil to a depth J3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ { Previous Application Made: Yes ❑ No 9 New Construction: Yes,❑ No� f t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' QISe tic Tank: Distance from nearest well —",—_-Distance from foundation___________________Material______________________________-_-______________- iXd,� No. of compartments___________---------------- --------------------------------Liquid depth---------------------- -Capacity_.' Disposal Field: Distance from nearest well dM9e_-Distance from f p �!C rn foundation___,��___.___-Qistance to nearest lot line_..______.. Number of lines---4r7n,A� ----------Length of each line ----------------Width of trench__._Z_#__//-------___�_____-- Type of filter materiall'A__ 0dA(__Depth of filter material____ _____ Total length-------------------- Seepage Pit: Distance to nearest well------._ _____.______Distance from foundation------------------- to nearest lot line________________ _ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------ -----Depth---------------------------•__-- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material______._________________-.--_____F___. ❑ Size: Diameter-----`--------------------------------Depth--------------------•-------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------------------____Distance from nearest building--_______________________--_--_____-____. ti ❑ Distance to nearest lot line---------------------- ------------------------------ . f Remodeling and/or repairing (describe= -�""` ----- ---------- •f% ----------------------------------------•--------------------------- --------------------- --------------------------------------------------------.----------------------------.....-------------------- 'P 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law , a d rules nd regulatioQof the San Joaquin �o'cal Health District. R E (Signed)._______•________ _-__ �__. +_ _ ( mer and/or Contractor) --- - --- --- - ------------- - --- -- ------ ---- - -------- -- By:------------- ----------- - ----- ' ---------(Title)------- �!° ------------ (Plot plan, showing size of lot, location of system in rel tion to wells, buildings, etc., can be place�n reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ - ----------------------------------- DATE- REVIEWEDBY--------------------------------------------------� - ------ DATE---- - �--- 3---s----�-------------------------------------------- ---------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------- DATE----- --- -------------------------------------------------- Aiterations and/or recommendations--- ------------- -------------------------------------------------- ----------------------------------------------------------------------------- --------------------------------------------- ------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:------ W--- ----------- Date-------------- #: 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 5-51 Revised W-2100