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5K_c.�rrl�� n, - -- - �5 - -rXI �a� APPLICATION FOR .SANITATION PERMIT ��-_� ------ -..------------------------------- ------- (Complete in Duplicate) � r= / -------- -- ------------ -------- ------ --- ----- This Permit Expires 1 Year From Date Issued Date Issued -' ----------- Application 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... ... cL Owner's Name.--- � ! ----- Phone st-�r Address '` `.. ----- ------------ ------------------------------------ Contractor's --------- - - --------------------------------- Contractor's Name .I / ..� ---- -------------- ----- Phone_��' �r P- 2 Installation will serve: Residence [9'00'Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _` Number.of bedroom's _- . Number of baths ...�.. Lot size mmunity system El [:1Depth to Water Table -------- ft. Water Supply: Public system D�o Character of soil to a depth of 3 feet,.-Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If,y�,fdafie....................J No _ �-New Construction: Yes ❑ No [3-SHA/VA: Yes ❑ No Ej-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.tank'or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt-----------------Distance from foundation--.----------------Material----__-.....___._.. Disposal ield�r, Dotance f omrnearest well .�__.--..Distance from found Liquid depth----.---------------.-----Capacity ❑ __ ___ . ' p ation-__16_.._.._-Distance to nearest lot G�.. l_ ne-y__ _.._,-.,T-_Number of lines.__....__-;L----�-------------Length of each h. -_--.-._..._. r __. .._.__. orencType of flter. material Depth s i of filter ma'terial_��"_- -___---Total length____.-...��-------------------------- .r Saepag Pit: Distance to nearest well------=7----------Distance fro foundation..- �� _.Distance to nearest lot line_... �r_le Number of Pits---------f__ Lining material-- _.� C Size: Diameter----3' _5 ." /'Deptn... , .---------------- Cesspool: [] Size�Diameter------_----------•- -,- -- anon Lining material-- -� --- �.. - �Distance i•om nearest well...=.......==�DDestth ce-from found Liquid�Capacitt--.._" :.._. p - --- ----ga s. Privy. Distance from nearest well. ------- - ----- -- .-...Distance from nearest buildingL --- Distance to nearest lot line___-.. ------------------------------------------------------------------------------------------------ - Remodeling and/or repairing (describe):----_-oea-' ...:772?----- ......... ----------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------- ------------ 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. (Si ned g )-------------------------- Plot, -.1� / C- ------------ --- w and/or Contractor) By------------------------ -- •------ �f ..— ------------------------------------------------------(Title) -- --+---- - -------------------- ------- Pot plan, showing size location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- DATE. - .�..� yy ----------------- REVIEWED G E -- IS -- E - ----------------------------------------------------------------------------------- DATE-----------;--= ------------------------------------ ---------------------- BUILDING PERMIT ISSUED ------------------- ------------ DATE.---------------- ----- - Alteraftions and/or recommendations:................. --- --- - ---- ----------------------- t - :: .. ..�_ - 2 e...K c X, - FIN L INSPECTION BY;.------ ------- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.q O.