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APPLICATION FOR SANITATION PERMIT Permit No. _q.9(".(o (Complete in Duplicate) Date issued .-71�5 y- 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 with CoUfy Ordinance No. 549, 4a ZSO Z5 CJ (Q� JOB ADDRESS AND LOC ION--------- --------- ---- - z.... --- ----------- Owner's Name ---- ------------ Phone---- -- r Address--------- -- - --- ---- , D..: Contractor's Name-..--,.--- .-----•------ ------------------------------------------------ Phone Installation will serR idenc Apartment House ❑ Commercial s❑ Trailer Court Motel Other ❑ if Number of . _��-/-- Number of bedrooms _-:.._-_ Number of baths- ----- Lot size -------------------- --------- Water Supply: Public system !e Community system ❑ Private ❑ "Depth to Water Table _ZQ-- ft, F Character of soil to a depth'of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑.Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes 00 No F-1TYPE OF INSTALLATION AND SPECIFICATIONS: i" (No septic tank or ce1s,spool permitted if publ'c sewer is available within 200 feet. Septic Tank: Mstance from nearest well -Distanc9 from and n-- - •--� ----.Mat � ----------� �----�-------•----- ,. No. of Ii�l mpartments.-_-__'2.__`---..--- --._Size�.1_- /� _-, - iquid depth_-.___- Ca pacity._-a _ f- .. Disposal Field: Distance from nearest well__ Distance fromi'foundation---1.-! -.-___-Distance to nearest lot lin -Q_____ Number� nes--'of li 1 ,------ --Length of each line_+ ��`.t'�Vidth of trench-_---. _----.- �y ----------- Type arl'filter material- T�-Depth of filter material--_ -_b .--_-Total length---_t!-6--- ..-_---__ Seepage Pit: Distance-to nearest well----------------------Distance from foundation----------..........Distance to nearest lot line_--------------- ❑ Numbelof pits----------------------Lining material-----------------------Size: Diameter-'41 --------.-------------Depth....._.--.-.-------_--__-_ Cesspool: Distance from nearest well-----------------Distance from foundation....... ---.-...Lining material---------.._-_-.-.--_----.___---- -_ 4 ❑ Size: Dium_ eter-------- Depth Liquid Ca aci - Privy: Qistonce from nearest well..._- }.-Dis#ante from nearesr buildi g � als._ ❑ Distancel'to nearest lot line__----------------- ------ --•-------------- -- -------------------------- -------------------------------------------------- - . l .---- Remodeling and/or repairing (describe): ----_ 1 ,� --- ----------------------------------------------- I'- _-_----__-_- {i//f ---•------••----••--------- ------------------------------- --------- -----------•- ----------------------- -----------------•----------•------------------------------•---------- --------------------•---------------- ------------------------------------------------------------ I hereby certify that I have prepa ed this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, an to s and gulations of the Sae Joaquin Local ealth District. (Signed)- r " -- -- --_. (Owner and/or Contractor) # BY--- - ------------------ -------------- Tale (Plot an, showing size of lof, location of system in relation to wells; buildings, etc., can be placed an reverse side) FOR DEPARTMENT USE ONLY ..1 APPLICATION ACCEPTED BY - - - - --- ------ DATE ------ ---------- BY--�-- --- -------------�-�- --- -----�-- ---- DATE----------�-- -------------- BUILDING PERMIT ISSUED- ---------------- �I -, DATE. -----------------------------•--------- Alterations and/or recommendations:.--------- ------------------------------ ------ =--------------------------- ----------- --------- _' ------ --------- -- -- i FINAL INSPECTION BY:-.-- rDate----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American S+reat 300 West Oak Street 132 Sycamore Street 814 North "C" S+ree+ Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 AT-ODD +