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APPLICATION FOR SANITATION PERMIT Permit No. ._��30 (Complete in Duplicate) Date Issued Applica+ion is hereby made to the Son 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------/�------- -------- ------- ---------------------------------------------------- Owner's Name---,-- ------ ------------ Phone------------------------------------ - ----------------------------------------- Address------- ---- ------------- ----------------------------------------------------------------------------------------------------------------- -- ---------------------- ---------------- Phone--#,/ Contractor's Name------� ------ Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel E] Other E] Number of living units: __/--- Number of bedrooms _._-,_; lumber of baths -_-/--- Lot size -----6--1------ ----6--1------ -------------------------- Water ------------------------ Water Supply: Public system `_Commuriity system [-] Private F] Depth to Water Table .65-aft. Character of soil to a depth of 3 feet: Sand E] . Gravel E] Sandy Loam E] Clay Loam ❑ Clay E] Adobe Hardpan F] Previous Application Made: Yes E] No K New Construction:. Yes 0 No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank; Distance from nearestDistance from foundation------&..........Material-------0------C--------&_ -,------ - __ No. of compartments----2----------------Size--,,,, ....Liquid -- - -------Capacity-----V-0------ I -------- Disposal Field: Distance from nearest well./07_1, isfance from foundation .. ........Distance to nearest lot ------- Number of lines-. -----------Length of each line------ Width of french -- ---- --------------------- Type of filter material_,/9......5_R__D,pth of filter material /--Total ------------ Seepage Pit Distance to nearest we13_ 44- ------ ......Disfance to nearest lot line-- ------- e p f k. 6-------------- --- istance jrorp foundation RL Num&er of pits------/-------------Lining materiaL.1W---- �ex�/Diamefer------ Cesspool- Distance from nearest well_________________Distance from founda.tion--------------------Lining material-------------I------------------------- 171 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------- -------gals, Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building--------------------- ------L-------- ❑ Disfance-fo nearest lot line---------------------------------- ----------------------------------- --------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- -----------•--•-------•-------------------------------- •------------:---------------------• ._....._ ........ --------------------------------------- I------------- ------ ------------------------------------------------------------------------------------------------- ------------------------------__----------------------- --- -------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- --------------- -------------------------------------- -----------------•---------------------•=------- ------------ -------------------------------------------------------------------------------------------------------- I hereby ce . y that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St e law nd rules and regulations of the San Joaquin Local Health District. - --------- -------------- ----(Owner and/or Contractor) (Signed ........... .. .... ------ ------ ------------------------0 L-10pr .1 - ----------- ----- - ----- ------- ------t---- ----------- - -------------- (Plot pian, s owing size of lot, location of system in re afion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------- ------------- ------ ------- ------------ --------------------------------------- DATE-------- -------------------------------------------- -------------- ---------- --------- -------------------------- REVIEWED BY-------------'------------------- --- - ---------- -- ---- --- -- ----------------------••-•---- - DAT -- BUILDINGPERMIT ISSUED----------------------------------- -- ----------------------------------------- ------------------ DATE- -------- ------- --------------------------- Alterationsand/or recommendations:_______-_-_____________ -- .. .. ..... --- - -------------------- ---------------------------------- ---------- ...... ---------------------- -------------------------- ------- ------f14... ter"_ --------------------------------------------------- -------------------------- r Z � --- ----11----------------------- '16 It---- ---------- -------- ------------------------------------------------------------- ----------------------- ------------ ----------- --------------------------- ------------------- -------------7---------------------------------------------------------------------- ------------------------------- --- - --- --------------------- ------------------- t - -----------I------------------------- -------- ------------------ - ------ -- ------------------------ --- - ------------------------------------ -------------------------------------------- ---------------------- .......I ...... FINAL INSPECTION 13Y:.------ -_, ------- ---------------- .... ........................ Date. = _X 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 Tfacy, California