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U�l APPLICATION FOR SANITATION PERMIT Permit No. ___413__4.. __ (Complete in Duplicate) � Date Issued ---..___-_ '/ 9(.- 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 withCountyOrdinanc o. '549. JOB ADDRESS AND L ATION.. l- - ---------------- - --------- ------------...------------------------------------------------------------_- Owner's Name----------- ^••---• -�---- ----•---------------••---------- -----: Phone------------------------------------ Address------------------- ----- � ------ - ----- ---------------------_-- -------------------------------------- Contractor's Name------------------------ -------•------- 4-----------------._. Phone.. ----------------- 1 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ____________�..____________________________________________ i Water Supply: Public system El Community system ❑ Private Depth to Water Table ,_ t. Character of soil fo a depth of 3'feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑. Clay ❑ 'Adobe &--H'ardpan [� Q Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ \�) TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) S tis,T T 4: Distance from nearest well-----------.______Distance from foundation___________________ Material-------------------- ______________._______ Ca- acit j7 No. of compartments-------------------------Size------------- ------------------Liquid depth----------------- p y----- Disposal Field: Distance from nearest well..,0_______Distance from foundation---le-_..__._..Distance to nearest lot lin `. ._.__.. f ______Length of each line of trench_._.___a�� _ Number of lines ------------- - ----------------- Type4of filter material-------------------------Dep h of fi r material-----------------------Total leng ----------------------------------------- .0 Seepage Pit: Distance to nearest well4v __ _ istanceFoundation ation_.='VP Distance to nearest lot line_ ________ Number ofypits.-_._�_- _-_-_-___Lining material _ p_ ize: Diameter___• .________Deptn_._s �____________..__Cesspool: Distance from nearest well_________________Distan a fro ....____.______.___.Lining material__:__-_____________.____.______-_____. ❑ Size: Diameter----- - --------- ----------------;-Depth------------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well................ ------------------------- from nearest building_________________________________________ 1 ❑ Distance to nearest lot line-------------=--------------------------- - -= -----=------------- -------------------------------------------------------------------- Remodeling and/or re firing (describe) ----------421,141 - --------------- --- i - ---:----- -------- ------------------- - •---••-----------• - •-•------ - - -------•------- -------------------------------------------------------------------------------------------------------------------------------------------------- ---------------•-------------------------------•-------------•--------•---•------•---------------------------•-------------------------------------------------------------..._ -----•-------------------------------------- I hereby certify that I 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) -- - ------------- ---- - --- -----. r Contractor) ------------ - - BY: (Title) ••+ � (Plot plan. showing size of lot, location ystem in relation to wells, buildings, etc., can be placed ort revers fide):` FOR DEPARTMENT USE ONLY i R APPLICATION ACCEPTED BY---- -------- --- ------------ -- ----------------------------------------------------- DATE------ •------------------•----------------------- REVIEWED BY -------------------------- DATE BUILDING PERMIT ISSUED............. •---=--- ---------- - ------------------- DATE-------------------�-��.--------------------------•---•- Alterations and/or recommendations:- - -------- -- �--- ------------ - - - - ----------------------------- ------------ - ---------- ----- ----------------------- -�--- � ----- - ! ------------------- --------•----------------------------------------------- � - ------------ ------- ---- -------------------------------------•--------------------- - -------------------------------------- ---------------------------------- -- -- ----- ....... .----------------- ------------------- -------------------------------------•--- ---•---- ----------- 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 ES-9-2M 145446 ATACUD 12.54 r