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APPLICATION FOR SANITATION PERMIT5 Permit, No, (Complete in Duplicate) Date Issued --- Applica4-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 ------------ Owner's Name_-__-__ ,- -el-------/r i�phone---------Z;,/k_1 ------------------------------------------ ------ ------ - ------ ----- ................ Address------- ---- -- - �_ __4'4 ...... --------- ------------------------------ --------------------------------------------- Contractor's Name- ----- --- - ----- ----- -------& ....... ---------------------------------------------------------;'Phone.2_49.------- ----e-7 Installation will serve: Residence Apartment House E] Commercial E] Trailer Court E] Motel 0 Other ❑ 1M-. A, - Number of living units: ----Z Number of bedrooms Number of baths .-/-- Lot size -----/-z� -- -------- -------------------------Ili ------- Wafer Supply: Public system E-] Community system E] Private Depth to Water Table-/' ffj:! Character of soil to a deptilh of 3 feet: Sand E] Gravel ❑ Sandy Loam [-] Clay Loam ❑ Clay El Adobe Hardpan E] ' Previous Application Made: YNo New Construction: Yes 0 No .1� es : TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) AeptiS Tank: Distan!ce Irom nearest well-----------------Distance from foundation__--.--.._--_.__ Material--- No of compartments---------- --------------Size-------------- •- -------------Liquid depth--------------- ------Capacity----=------------- --- Disposal apacity------------------ Disposal Field: Distance from nearest Distance from foundation----3 ------Distance to nearest lot line----------------- Er-C.4-, Number of lines----------- ---- ---Length of each line-------- f�,Irench------AF_�_/-.--------•--•--__-- Type ---- ---- - Type O'T filter material-_!;SiA04.__Depth of filter material-_.. -----------Total len gth-------- to nearest w -- --------Distance om f unda ........ _7 Seepage Pit: Distanceell-1:04,- -/-- f ion----20 Distance 'to nearest lot line,--,S---------- Number of its._ ____.---_; ----------- Linin material..-l7_ Size: Dia meter.- ------ Depth-------7.-S7------------------- j Cesspool: Distance from nearest well-----------------Distance from foundation------------- ------Lining materia)------------------- - - --------------- El Size: Diameter.--..-------------------------- ------Depth---------------------------------------- 11 ----- --------Liquid Capacity---------------------------gals. Privy- Distance from nearest well----- ---------------------------------------..-.-Distance from nearest building___.____,___._ - - �] ❑ 1. Distance to nearest lot line-------- -------------------- ---------------------------------------------- Remodeling and/or repairing (describe):_--_-__._--__._---_ ------------------------------------------------- ------------I ----------------------------•--------------'--11 -----------------------------------------------------------------------------------------------I-------------------------------------------------_-------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------ - ------------------------- ----- ----------------------------- ----------------------------------------------------------------------------------------------- .1 ----------------------------------------------_---------------------------------------- I hereby certify that I!!have prepared this application and that the work will be done in accordanc4 with San Joaquin County I ordinances, SfafeAa�, and rules and regulations of the San Joaquin Local Health District, ii y (Signed)--------------- ---- ------- ---------- ---------------- -----------*----------------------- -------(Owner and/or Contractor) 1� ----------------------------------- By: ...... ------- ---------(Title)---------------- - -------------------------------------------- (Plot plan, showing size o 1,o t, location of system ip'41afion to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY------------- ------------------------------ ------------------------------------------ DATE--------------- REVIEWED BY--------------------- ------------------------ --------------- ------------------------- DATE BUILDING PERMIT ISSUED--------------------------- I ------ ------------- --- ------------------------------------- DATE. .Alterations and/or recommendations:-________________1_...._ -------------- ----------- ;;;---------------------------- _;_ --- ------ (X7--- -------- ----- ------rl_-_ ----------- ------ - -------- ----------- ... -------------- ----- &t-4-�r - ------------ - - -- ------------------ ----- ------ P ------------------------ -------- ------------ --------------------------------------------------- -----T_----------------------------------- -----------------------------------------------i� ;: 11, --------------------------------------------- -------------------------------------------------------- ------------------------ - -------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY; `7 _0 ------------ _- -------------- Date...."/. ---------.--.---------------------••--- SAN ----- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Sotjfh American She 300 west Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E-9 145446 ATWODD IL