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APPLICATION FOR SANITATION PERMIT Permit No.44--p----- (Complete in Duplicate) Date Issued -y�4 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h ein described. This application is made in com It n e.with County Ordinance No. 549. n1 OB ADDRESS AND LOC TION.. - ----- -- -- Owner s Name-------------- - -- -- -------------- --•------•----- ----------------------- ---- - ----------------------------- ----- Phone -----.----- Address----------------------------••-•-.-- -----• •----------------------- ------••-------------..-----------••----•--------------------------.---- ---------------------•-••-•--------. ---------------------- A�Z Contractor's Name ----------------------------------•----- Phone. ---- ------ -------- Installation will serve: R ' ence ❑ Apartment4House ❑ Commercial�Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ----------------------------------------------------------- Water Supply: "Pt7blic system ❑—00rhrnu-ntty'system'❑ Private❑ Depth_t Water'Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa`ndy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ W r � Previous Application Made: Yes ❑ No ❑ t New Construction: Yes ❑ No,❑ m TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted"if public sewer is available within 200 feet.) CCl S c Tan ' Distance from nearesT wail-------__.___---Distance from foundation---------- _-_-..---Material_--.----__----------------------------------_-. ,No. of compartments------ --------- Size------- -----------------=---Liquid depth------------ .......-----Capacity---•------------------- V Dis os I Field: Distance from nearest well _`r' Distances'from-foundation--------------------Distance to nearest lot line..------__------- Number of lines-----------------------------------Length of each line------------------- Width of trench------. 0 f.-______-_-- g �f-f---- Type of filter material_. - _r_ -------Depth of filter material__--- ---.-__--.-Total length_-_----...-_-� a--------------•-- Seepage Pit: Distance to nearest well------------------_--Distance from foundation------.------------ Distance to nearest lot line__-----.---._-.-- ❑ I Number of pits----------------------Lining material-..-------- --------.Size: Diameter------------------ ----Depth---------------------------- Cesspool: Distance from nearest well-------.__------Distance from foundation-------------------lining material---------.----------------- aIs. Liquid Capacity------------------------ 'I � Size: Diameter--------------------------------------Depth--------------------------------------------------- g Privy: # Distance from nearest well Distance from nearest building___--.._- _----------------------------� ❑ Distance to nearest lot line-------- --------------------------- -------------------- ------------------------- ------------------------- �. ------------ Remodeling and/or repairing (describe):--------- --------- t. r ----- ---- - - ; ------------------•-•--------------�------------------------------------ -------------•--------------'---------------I-------------------------------- 1 I ---- ---------------------------------------------------------------_--------- - -----------------------=--- r� = ; I hereby certify that I have prepared this application and that the work will be�done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the Joaquin Health District. i - ws ------------------------ ------------ (Signed) ----(Owner and/or Contractor) ---------- ----- - --------------------- -�' ! -----------------------------------------(Title)-�;•-------------------- -------------------------------------- (Plot plan, o ing size of lot, ocatio system in relation to wells, buildings, etc., can be placed on reverse side). { FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED BY---------- t ---------- h` ------------------------ DATE ` f -- -- - ------ -REVIEWED BY--------------------------------- BUILDING PERMIT ISSUED-------•--------- ----- ------------ DATE --------- Alterations and/orr recommendations:=-n--- :--7-----`"" _ K. . . -_ ------ ---------•---•---------••--------•I---•---------------------------------- ---•------------------------------------------------------------------------------------------------------------------ ---------- ------------------------------------------------- ---------- ------•--------------•------------------------------------------------ FINAL INSPECTION BY:-- Date-- r -------------- 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 10-52 Revised W-2100