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APPLICATION FOR SANITATION PERMIT Permit No. .,,/ (Complete in Duplicate) Date Issued f7/ A -ion is hereby made to the San Joaquin Loca! Health District for a permit to cons rucf and i fall the work herein described. This application is made in compliance with County Ordinance No 549. JOB ADDRESS AND L ATI N -1----I------------- ----- --- -------- ----------- - ---- ----- ----------- ----- ----------------------------------------------------- Owner's Name--------------------------------- ------- ----e- --- ------ - ------------------- -- ----- ----- --- ---------------------------------- Phone------------------------------------ --- - ------- --- --- ---------- Phon 5- --------2 ------------- Contractor's Name___----- Installation will serve: Residence t- ApactTenf House F] Commercial El Trailer Court L] Motel ❑ Other L] Number of living units: /---- Number of bedrooms Ar.--Number of baths ---L Lot size ....... V 01------------------------------------ Water Supply: Public system Community system [] Private El Depth to Water Table 5�s ft- Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy.." E] C E]Loom El jay-Loam Clay E] Adobe &—Tqa"rdpan ❑ Previous Application Made: Yes El No V� New Construction: Yes 2��No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: .I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Septic ,;p el— -Distance from foundation—..................Material------------ No. of compartments--- e-------------------------------Liquid depth----------- ------- Capacity------ from neareff Disp sal Fie Distance "Ir.00WIstarce from foundafion--/-\5'-""--.-.Disfance to nearest lot linel-0------ Number oi lines----- _--__Length of each line \57'---------Width of trench.......Z or ( oo ----------------- _Type T filter epth of filter mafer�al___,/_?_...__ Total length------9__L5----------------- -------- Seepage Distance to nearest welIA14- - ------------Distance from fo d ion-------��:/; Dis+ance tonearestlot line- Number of pits-_9)A 4_-------Lining material-a--- Diameter lanZle: biame r-------�Z_,Z......Depth------?-is----:�-------------- - Cesspool: Distance from nearest well-------------------Distance from foundation--------------------Lining material__._-______________-___________--__ . �= ❑ aterial--------------------- --------------- El Size: Diameter-------------------------- ---------Depth------------------------------------------- Pr;vy: Distance from nearest well- Liquid Capacity-------....................gals. Distance to nearest lot,line_____________________-------------- ----------________________--_Distance. from nearest building-.------------------ -------------------- -- - ----- ----------- ---------- ------------------------------------ ----------- t Remodeling and/or repairing (describe):---------------- -- ---- --------- _ _ _ - ------------------------------- ---------- --------- •--- -------- - ---------Z- ----------- ----------- --------------................------------------------------------------- ------------ -------- ------------- ------------------------------------ I ----7_-�---------- -------------------------------------------------------------------------- -----I------ ------------------- I--- ------------------ ----------------------------------- ---------------------------------------------------------------------------------------- ------------------ -------- ------------------------------------- ----------- - ----- -- --- ------ ---- ------ -- - - ---- I hereby certify that I have prepared this application and that the ork will be one ii n accordance_w,ifh__San'-Joaquin' C-o-County ordinances, State laws, and rules and gulafions ofe San Joaquin Local Healt District. �O 7 (Signed)----- ----- —...... .. . ... ..... --------------------- ------------- --------{O d4Rtan--------------------------------- ontractor) By: Title ------------------------------------------------------------------------------------_--ff )------ --- - ------------ ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)- - ------------- t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------------------------------------------------- ---------- ----------------------------I DATE-' REVIEWED BY —------------------------------------------- ---------------- .... ............................ ---------- DATE-- BUILDING PERMIT ISSUED Alterations and/or recommencln s----------- ...... atiq -- -------------------- DATE. ------:---------------- .--------------- ---•- --------------------------------------------- \ ..... ----------------- ------------------------------------------------------------ ----------------------------------------- ................. _ ------------------------------------------ ----------- -------------------------------------- ---------------------------------------------------I------------------------------------------------------------ ----------------------------------------- 49 ----------------------------------------------.......... ---------------------------------------------------------------------------- ---------------------------------------------- ---------------------------- ---------------------------------- ------------------- ------------------ ------I-------- ------------------ ---------------------------------------I----------------------------------------------------------------------- FINAL INSPECTION BY:1� �__--e-2--5------------ ----------------------- Date._ _- 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 145446,ATW000 12.,94