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APPLICATION FOR SANITATION PERMIT Permit No. ....l:v.0 L (Complete in Duplicate) Date Issued _____�__.__ Applica4ion 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 Or - ance1---- �o. 549. JOB ADDRESS AND LOCATION... - �_ A._641,1412,42xi 9)e2 Owner's Name --- ---._... Phone------------------- ---- Address-------!-- .9,. -------- -o Contractor's Name ------ Phone--------------------------- Installation will serve: Residence Apar ment House ❑ Co mercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �I l Number of living units: --- __ Number of bedrooms ___.._-. Number of baths --- Lot size ____T/_.,k�-___ ----------------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 0 Previous Application Made: Yes ❑ No Pq New Construction: Yes)K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic-Tank. Distance from"nearest well .___.________Distance from foundation-------------------Material____._:__-_.___.___ --__________-.. No. of compartments----- - ---- -------------Size--------------------------------Liquid depth--------------------------Capacity--------------- ------- ie d: Distance from nearest well-____----------__Distance from foundation_____--___..___.__.Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french-------------------------- ----- -- 0 Type of filter material-------------- ------Depth of filter material-----------------------Total length---_-----------'------ ------ C LLa See a e Pit: Distance to nearest well--- __6V- 70istance from foundation______ _._Q._.___Distance to nearest lot line-----sem_-----. U A Number of its----------�_----- _-- Size: Diameter--------- 1 p 6 �J �nce Depth �Zg -A- o : Distance from nearest well______________ foundation-------_____------- Lining material-_____-...____.____._._______----___. '/� Size: Diameter________________ _ Depth _ Liquid Capacity �y ❑ -------- - ---- - p q p y---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------.--_-_----------- ❑ Distance to nearest lot line-s----=---------------- ---------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) ------------- ..t ----- 4 ------ --------------------------- ---------- --------------------------------------------------------------- -------------------------------------•-----•-------------------------------------------------------------...------------------------------------------------- •---••------------------------I------ ------------- -- I hereby certify that l 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. (Signed),., -----,(Owner and/or Contractor) BY: --- -------------------------------------------------------------------•-- ------------•-(Title)------------------ -- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------- ----------------------------- ------ ---------------------------- DATE REVIEWED BY ------ ------------------ DATE _�_ w BUILDING PERMIT ISSUED----------------------------------- -- - --- ---P -- ---------------- DATE Alterations and/or recommendations:-------__-------------- -- ------------ ----------•---••--------------------------•----•-•---------•-------------------•------------------------------ - - ----- -- - --- ---- - -• - T - --------- ----• -•-'t'�'---- - ------ -- --- - ---- - -------- �- - -��--��------- - -------- .mcg -F 'h. �. ----------------------------------- l 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 E. --$ 145446 ATWOOD d