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APPLICATION FOR SANITATION PERMIT Permit No.3--- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install flne work herein described. This application is made in compliance wjjy>/Count Orclin;n, No. 549. 45F4,F_aC^f774 S-rk � - JOB ADDRESS AND Apartme House F LOCATION--- ------------------------------'---------------------- Owner's Name----------- -V+____ - --------------------------- ------------------------------- ---------------- Phone_----------------------------------- Address------- --- 45) -- - ---------------------------------------------- ---------------------------------------------------------- Contractor's Name------------------------------- ---- ------------------------------------------------------------------------------------ Phone----------------------------------- rr Installation will serve: Residence Commercial F] Trailer Court F] Motel F] % her Ej Number of living units: -/-- Number of bedrooms _-__ umber of baths ___V Lot size Water Supply: Public system El Community system E] Private'a Depth to Water Table ---I--- ff. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam [] Clay El Aclopol� Hardpan Ej Previous Application Made: Yes [] No X New Construction: Yes EY No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if puillic sewer is available within 200 feet.) Se5fi� Tank: Distance from nearest well_____ 0---.Distan from o0afion-----/_0---------Maf r'al-----6- _�-- --- __________. .......... ...Size.... clepf� ...... No. of compartments----- Liquid ---------------Capacity___ --- --- - ----- ho Disposal Field: Distance from nearest well.....13-0---Distance from foundation----I AVP------_Disfance to nearest lot lige---/0------ Number of lines-----------Z--- I-ength of each line------ -Width of trench____,?0_Fir----------------- 11------------- Type of filter material-----)4__kACf_Depth of filter material-7---l? -;'--Total length____-___/0-A0-------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_________________-_Distance to nearest lot line___________-___- Q_ F-I Number of pits----------------------Lining material-----------------------Size: Diameter----_------------------Depth-----_--------------- L Cesspool: Distance from nearest well_____.__________Distance from foundation--------------------Lining material------------------------------------:'-- ' F1 Size: Diameter----------------------- --------------Depth---------------b------------------------------------Liquid Capacity----------------- -----.---gals Privy: Distance from nearest well___________________________________.__ __________Disfance frorh nearest building________________-:.___________________ � ❑ uilding----------------------------------------- EI Distance to nearest lot line- -- -------------------------- ------------------------------------------ ---------------------------------------------------------- Rem*ling and/4j4repa1rFi4j-d cr e):-----3 ------------------------------------------------------ ---- 6A - -- ------- ---------- - ------ --------- ----- 0 1�------ ---------------------------------------------------------------- - a-1------------------------------------------------------------------------------------------------- ---------- ---- --=--------6-4 -------------- --- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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)___k lt i ---------------- --- -- -- ----------------------------------I--------------b------------------------------------------------ -.---jOwner 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--------------------------- REVIEWEDBY--------------------------------------------- -- - ----- ----------------------------b-------------- DATE---------�J__.-e_ a 4� BUILDING PERMIT ISSUED------------------------------ - ------ -T - ----- ------------------b---------------------------- DATE----------- -------------------------------- Alferationi and/or recommendations--------------- ----- --------------- ----------------------------------- Aac --------&-p- _30- --- ---- -f-A A--------- letlf__4-------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------------------'tet------------- - ---------------------------------------------------------------b------------------------------------ FINAL INSPECTION BY: 4_1<21 ---------------- 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 8-51 Revised W-2100