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APPLICATION FOR SANITATION PERMIT Perm7to. _�,v, (Complete in Duplicate) Date Issued ___ / Npplica-%n is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. s application is made in compliance with County Ordinance Thi 'No. 549." I JOB ADDRESS AND LOCATION-- --- "--: I Owner's Name-------�! /_� -----------------------------------I--- ------------- l�°�-------------------------------------- ----- -------------- -- Phone...... Address - --------_-- -------------------•--------••--••-------------------•-------- Contractor's Name-------••---- R .--- (. 1--. -ems -- - ------- _ Phone Installation will serve: Residence�"Apartment-House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---6!:"Number of bedrooms __ __ Number of„bathst:f , Lot size . � ”"-- -_( ?- Q ------------------Water Supply: Public system 91�Community system El �ivate . De th to Wafer Table A47`ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 'Sandy Loam [❑ Clay Loam ❑ Clay El Adobe ®""i=lardpan ❑ Previous Application Made: Yes t No ❑. . �" New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ank: Distance from net well___________ _"___Distance from foundation-_.__ :----------Material ,,..,,Sepf T No. of compartmenfs---------- ---------------Size--------------------- --------- Liquid depth -------------------Capacity-•-------------_-------- I --- ar f Disp ' RI Field: Distance from nearest weff__ fDistance from foundation-__ - .Distance to nearest lot line___ __-___-. ' 4 Number of lines------- -------------------"-- --Length of each line--------- _� "' .--fWidth".of trench------ :�--- Type of fitter m terial_,� -__/ __- "-___pepth of filter material__._ -I c'�a2To+al length_.__"A' ------------------- Seepage Pit: y Distance to nearest well----A&V?,"Distance from foun .tion.-_'�_4..!_",Distance to nearest lot line__ Number of pits �_-----------Lining material _ Size: Diameter„„ _��----------Depth_____-------------- Distance _" " ------- 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-------------------- ❑ Distance to nearest lot line-------____________"._____...._" � Remodeling and/or repairing (describe):."._--------- ---------oL (� _____________---------------------------------------------------------------------------------------------------------------------------------------------------------------- _____________________________________________________ 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. f r - (Signed)------------ ------- /".� ----------------- - --- - --- --- - - - Contractor) i BY: t ------ ---[r+lel �........-------- -- (Plot plan, showing size of lot, 1, .tion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION .ACCEPTED BY---------,�.-_ --------- ` __ DATE___ ----------- I EW G' BY PERMIT ' ----- DATE `._ BUILDING PERMIT ISSUED _ - - DATE �1-- - Altera+ions a or-r commendations:_'_____.___._ �^ -------..---•----• ----.----- `"' Win. -------- FINAL INSPECTION BY:------ --------------------=------------------ Date---. ---------- SAN JOAQUIN LOCAL HEALTH'DISTRICT . 130 South American Street ' 300 West Oak..Straet 132 Sycamore Street 814 North "C" Street Stockton, California t Lode, California Manteca, California Tracy, California ES-9 145446 ATWcon