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N I APPLICATION FOR SANITATION PERMIT Permit No. .. l (Complete in Duplicate) �O 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------- 1------ _a-------- ---------•---------------------------------------------------------------- Owner's Name...- ` --- ---------------=------------------------ Phone------------.----------------------- Address---------...%!� -.1_------... ..6�I1.._ ` � = # Contractor's Name------ aa------ � Phone/ .. 44� Installation will serve: Residence a Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: _/.-___ Number of bedrooms _Number of baths __/`---- Lot size ... -------_-_1.>-6--------------------- Water Supply: Public system Ac Community system ❑ Private ❑ Depth to Water Table dit. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,g oardpan ❑ Previous Application Made: Yes ❑ No 09—. New Construction: Yes P�f__No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r r Septic Tank: Distance from nearest well_&-GYtR--0istance from foundation_ __._____.Material___�G_____ __________ ._ ----------- (�} No. of compartments_____. Size_._ P-- - ------Liquid depth__.__..._ p y..__ pp____ I Disposal Field: Distance from nearest well...Md'?XWZistance from foundation____ a ___._.Distance to nearest lot line----Zic------- [� Number of lines---------- -- --y�-. _ ---Length of each line------- ------------.,._:._.Width of french------ _ f Type of filter mater:al_.�.�----- epth of filter matenal___,�_S __ _ Total length___. ____________ Seepage Pit: Distance to nearest well__- s.Bistance f fouu dotion-__....___.Distance toynearest lot line_._."__`___, } Number of pits._..____- Lining material_�n 1: E Diameter____r ___.De,pth__.__��____ _ Cesspool: Distance from nearest well-----------------Distance from foundation.------------------ Lining material-----_------------------.._-_________ ❑ Size: Diameter.-_.--------------------------------Depth--------- - ------ --------------------- - --------Liquid Capacity............................gals. Privy: Distance from nearest well-------------_________________________---------__Distance from nearest building------------------------------------------ F-1 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe)- ----------------------- -------------------•--••-•-•-•--------•------------------------------------------------------------------------------------- - -----------------------------------...-------------------------------------------------------------------------------------••----------------------------------------------- -------- --•------------------------------- ----------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------•------ ---------------------------------- 0 I hereby certif t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat a , and rules and regulations of the San Joaquin Local Health District. 5 Owner and/or Contractor 5�gned ( / 1 Plot Ian, showing size of lot, location of system in relation to wells, buildings, etc., can ________________________________ - ( p g y g an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ ...... -----•-------• ----------------------- DATE------------------- REVIEWEDBY------------------------------------ - ---- DATE------------ BUILDING i -------- - -- ------------------------•------ BUILDING PERMIT ISSUED------- DATE----------- --- Alterationsand/or recommendations:---------- ------------------------------------------------------------------------------------------- -------------------------------- -------•-• ----------------------------------------•-------•-------------------------------------------------------- .....------------------------------------------------------------------------------------------------ ---------- --------------------------------------- ------------------- ---- ----------- ---------------------------------------- -------- -----•---------------------------- ---------------------------------------------------------------------------------------------------- ----------------------------------- FINAL INSPECTION. BY:��__ ._. Da+e_._.,/.__ _ _ 1 ------ ----- ----- --------------- SAN JO QUIN LOCAL HEALTH DISTRICT 130 South American Street- 300 West Oak Street 132 Sycamore Street 814 North "C" Street 1 Stockton, California Lodi, California Manteca, California Tracy, California i E5-9 145446 ATWOE10