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APPLICATION FOR SANITATION PERMIT Si a Permit No. (Complefe in Duplicate) 1 Date Issued Applica--ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This a plication is made in compliance with County Ordinance No. 549. �. <s JOB ADDRESS AND LOCATfON..._ _ e l• 'fir► ' :: ► .._. ,, r'--�'�Owner's Name----R 1t0A7---_1f ._ -- - --.----------------------------- ---- -- Phone__----------------------- Address------------- --- -----+--------------------- Contractor's Name__. uA,-----•-----•`------------ -- ---------- Phone.--------------- _ Installation will serve: {Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E❑ Other ❑ . .'Number of living units: -1----- Number of bedrooms J___. Number of baths------ Lot size ---------------------------_---___ Water Supply: Public system'R Community system El Private F1 Depth to Water Table ---.--- ft. .Fa Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam M Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes_❑ 'No JR] New Construction: YesX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No sepfic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-_-s d___-.'__.Dista from foundation.-.1--------------Material__.._._________.._._..-----._----_-----._-_-__--. No. of compartments _ Size._ --Li Liquid de th_......._. ® P -��-----� ------- q P. .-------._Capacity--�Q a------------ Disposal ----------Disposal Field: Distance from nearest well-_-$ ___-._Distance from foundation-39.............Distance to nearest ]of line__a ......... Number of lines-__._ _________.- _ Length of each line--- ------------------- ine--_ d Width of french-_.�- ' ip4 g ---- N-------- �� ---------- Type -----..Total length--/,Pa Type of filter matenal._JPf�..-.-De Depth of filter mater�a!__��..,__.. ____________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line----------------- El ofpits-'--.------------------Linin material-__---.---- -.Size: Diameter--..--.---__.--- ---_-_--.-___-�,� ❑ ' � g -------Depth---- - - p Brest well from foundation-------_.-..---.---.Lining material--.-_-.__-.---.-.._.----.-_-_-_-- I ---------------- Cesspool: Distance from ne.l , Size: Diameter.-- ------Depth------------------------------------------- ------Liquid Capacity----------------------------gal+ . Privy: t nearest well__________________________ ______________________Distance from nearest building_---._____.__.__---____________._______, Priv❑ Distance from ne, ' Distance'to nearest lot line---- -- ------- ------------ Remodeling and/or repairing (describe)--- ------ -------- ---------------- --------•.------------------------------------------------ --------------- ---------------------------------------------------------------- --------•--------•----------------------------------------------------------------•------------------------------------------------ ------------------------------------------ -------- •--- -•-----------------------------------.. .---.----....--------------------------------------------------------------------------------------------------- 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)- {Owner and/or Contractor) By:---------------=--------------------------------------------------------------------------------------------------------------------(Tit le)-------------------------------------- ---- --------------- 4 Plot-plan,_showing size of lot, locatiori of-s stem in relation tb=v+elfs buildin s etc. can be= aced'onJreve�se side " = f- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- . - - -- ---- --------------------------------------------------------------- DATE----L-=Cflr7----- REVIEWEDBY------------------------------------------- - ---------------------------------------- --------------------------------------- DATE------------------------------ BUILDING PERMIT ISSUED..................•-----------•--------------•------------------------------------------------------ DATE-•-------------- - ---------------- ---------------------••--•- Alterationsand/or recommendations:--------------_--------- --------------- --------•--------•--------------•---•--• -----•-•---- --------- ----------------------------------------------- ---------------------------------------------------------------------------------------- -----------------------------------------------------•---------------------------------------•----------------•-•-------------.-_-. ---•-•------•------•---_-------•-------•------------------------------------------------------------------------------------------------------ -------------------------------- ---------------------------------------------- ----------------- FINAL INSPECTION BY:_..- {�tYY ------- ---------------- Date-- �. -------------- ------;.7_........ 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 E5-9 145446 n-rwoao