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APPLICATION FOR SANITATION PERMIT Permit No_ ________________7.__._ (Complete in Duplicate) Date Issued Applica+ion 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 .-- -- 3 -!' ...- Owner's Name-------------- ------------•---- --------------- -.-- - Phone.._. .. Address----...... -- � f' -----------------------------------•------------------------------------------•-- ------- / - --------- I--------•----------------Contractor's Name -------- ----- BT Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _J-.- Number of bedrooms _ -.. Number of baths __/___ Lot size ____ QlrG_______________________._ Ih r Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand [-] Gravel F1 Sandy Loam ❑ Clay Loam F1Clay E] � Adobe lardpan ❑ Previous Application Made: Yes ❑ No Rr New Construction: Yes ❑ No TYPE OF INSTALLATION! AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ill, Sept" Tank: Distance from nearest well_________________Distance from foundation--------.-----------Material ___________.__il_.._________...._.----.---__.__. No. ofl�compartments-------------------------Size--------------------------------Liquid cl,pth. -------------------_._.Capacity----------------------- Disposal Field: Distance from nearest well_—! �---_ Distance from foundation----�11._-------.Distance to nearest lot line--- Number of lines________ _.................. . Length of each line-------- --- Width of trench-k- $............... Type of filter material- ___ Ltr/ Depth of filter material___.��__.._.___Total length._._.. _�___________________________ / li� Seepage Pit: DIt istance to nearest well_____/0-p__--____Distance fram fono�tion__...4�_______.__.3�istance to nearest lot line__ Number of pits------- _____.____._Lining materiaL0_C__-8ij ize: Diameter__3 3.... ___De thl..__. X,� _1 Cesspool: Distance from nearest well--------- Distance from foundation___-----------------Lining material---_:_------------------------------- . El Size: Diameter---- ----------------------------Depth--------------------- ---- - ------------ ---------Liquid Capacity-1M-------------------------gals. 11. Privy: Distance from nearest well_________ _ ____________ ____.____----___________..Distance from nearest building--------I-_ -.___________-_________----- ❑ - Distante to nearest lot line-------- -------------- -------------------------------��- _ ------- - Remodeling and/or repairing (describe)----------------- 1I�/l '---- -------------- 1� 1 ---------•-•"----- -I---- --- - -- - -------.-- iii - --•------------•------------------••------ . 'I -------------------------------------------;i.�---------------------------......----------------------------------------=-------=-----------------------------------------_•------ I hereby certify that1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' r Itor)(Signed)----------------�Q �-- By:-------------- ----------------------- -------- -------------------------------------------(Title)-------- � (Plot plan, showing size of�lot, I tidn of system in relation to wells, buildings, etc., can be placed on reverses e). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- -._._�----------------- -----------------------------------------•------------ DATE------='-----"".._��-------------------------------- REVIEWED BY----- f----••--•------------------------ BUILDING PERMIT ISSUED------------------------- - ---- DATE---------- 'I ------------------------------•- 1 �a ---- ----- ---------------------------------------------------- Alterations and/or recom -------- ____ __ ' 0----------------------- -------- %- ------- -------------------"------------.------•-------------------------- ,I� ---•-•--------------.. --- -- -- ------ --------r - - -------------------------•- ----••--------•---------- •- ---------------------------- ;l� -------• ---------- --- �, --------� ------ - �� --- �----.-.---- ----- �------------- ------ _Y 1 FINAL INSPECTION BY: -------------------- ------------- 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 4 Er-9-2M 145446 ATWOao 12-54 Il .