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APPLICATION FOR SANITATION PERMIT Permit No- ----- '....(-- -_-- - ` I (Com lete in Duplicate) Date Issued _-.`_f_ _____s.. 11 u lira{ion is hereby made'to the San Joaquin Local Health District for a permit to construct and install the work herein described. • its application is made in compliance with County Ordinance No. 549, --------------------------------•----------------------- --------------------------- JOB ADDRESS AND LOCATION----' -_-------G------- �-:1t f .- --------- ------ a Owner's Name --- - -- Phone- -•-J` .1 Address `2 - 1 !nC '- --•-•-------------------------------------------------- -----•----•-------•-------•----- ..: .. Contractor's Name---- •-------------=' -------------- ----------------------• •- - Phone. *7T 3- Installation will serve: Residence M---Apartment House ❑ Commercial ❑ Trailer Court ❑ • Motel ❑ Other ❑ Number of living units: --1-.-- Number of bedrooms __ -_. Number of baths __f__-._ Lot size __r0__Q._..-_-__-� ti�_______________________ Water Supply: Public system ❑ Community system ❑ Private 2-�_Depth to Water Table 2_a ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam El Clay Loam ❑ Clay ❑ Adobe�lardpan ❑ Previous Application Made: Yes F] No 0 Naw Construction: Yes &KNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SSeJptjc T� l- l- Distance from nearest wel ----------------Distance from foundation__--_-_--------__--Material------------------------ No. of compartments----- ------- - ----.--.-.Size--------------------------------Liquid depth.-------------------------Capacity----------------------- Disposal Fi Id: Distance from nearest well-----------------Distance from foundation------------.-.----.Distance to nearest lot line_-.-__--__---.-_. Number of lines-----------------------------------Length of each line------------------------------Width of trench._._-----------_--_-.----__._----_- Type of filter material __-_—__._..'`�._.____Depth of filter material-----------------------Total length__________________________________________ See pa Pit: Distance to nec�Fest well---p_ ..........Distan e from foun ation---Q-------------Distance to nearest lot -3 Dumber of pits.- -r_ _ _ ___ ._.----_:_ Lining material------ +ze: Diameter._- d----------Depth-..-..-----�-------------�__-- Cesspool: Distance from nearest well-----------------Distance fro a ._ ,.�_— ___.Lining material- ___ _- ___ �,�.�� ❑ Size: Diameter--------------------------------------Depth-.------------ ------ -------- ------ ----------Liquid Capacity----------------------------gals. . nvy: Distance from nearest well------------------------------- _--____--_Distance from nearest building---------- ------------------------------ ❑ Distance to nearest lot line-------------------------------- n -A ----------------- ------------------------ ------------------------------- (Va Remodelin and/or r pairing (describe):- - - ---- -----•--- A - ---------- ---- -------- ------------------------------------------------------------------------------•-------•-----------------------------------•--•------•-------------------------------------------------------------------------------- l+ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--� ---•- - ----------- --------------------------- -------•--•----------- -----------(Owner and/or Contractor) By:------------ -( 1-- - --------------------------------------- ------------------------------------(Title --- ---- - - ------------------------------ ------ (Plot plan, showing size lot, location f system in relation to wells, buildings, etc., can be placed on iWverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------_------ --- -- - --- --------------------------------------------------- DATE--------- � �. 0 . REVIEWED BY--------------------------- ---- ------ ---------------- DATE--------- ------------------------ ---------- BUILDING PERMIT ISSUED----------------- ---------- - -----• DATE.--------------------------- Alterationsand/or recommendations:--------------------------------------- ------ ---------------------------•----------------------------------•--••- ------------------------------------------- --------------------------------------------------------- -------------------------------------------------------------------- ----------------•-----------------------------------------------------•- ---------- --------------------------•------------------------------------------•-------------------- -------------•-----------------------------------------•----------------------------------------------------------•--- ----------------- --------------------------------------------------------------------------- --------------- ------------ ------------ ---------------------------------- -------------------------------------------------- FINAL INSPECTIONBY: ----P-`------=- �'-�- ----- Date..... - D/y M -----------------------------------•---- �' - � ij SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sheet Stockton, California Lodi, California Manteca, California Tracy, California y E5---9-2M 145446 ATWQUD 12-54