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.. 7 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica-1-ion 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. JOBADDRESS A CATION-------- -------0,---- - — - ---- -------------- ------------------------------------------------------ ... . .... .. . ------------------------/ ...... Owner's Name- ------_------- --------- ----------------- Phone— Add - -- ----- . ... ...... .......... ----------------------------------------------------------------------------------------------------------------------------------2 ------------- .. ---------- Contractor's Nam ------ ----- Phone. ...... Installation will serve- Residenc`e ,X Apartment House ❑ Commercial ❑ Trailer Court [] Motel [] Other E] Number of living units: Number of bedrooms Number of baths _/--- Lot size ----'6:_ ---------- - Water Supply: Public systerX, Community system [I Private El Dep th to Water Table4Xe9ft. Character of soil to a depth of 3 feet: Sand E] Gravel L] Sandy Loam [] I Clay Loam Ej Clay 0 Adobe Hardpan ❑ Previous Application Made: Yes L] NoA New Construction: Yes 1K No TYPE'OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) Septic nk: 1 y Distance from nearest well________________Distance from foundation------------------..Material------------------------------------------------ No. of compartments----------- ------- -----Size_---------------1--""----..Liquid depth--------- ----- ----------Capacity----- ------- Disposal apacity-----------------------DisposalFeld: Distance from nearest well----_------------Distance from foundation-______ __.Distance to nearest lot line_--"_____________ Number ine------------------ Number of Jinesl----------- - -------------------Length of each line----------------------- -----.Width of french------------- ---------------------- Type of filter material--------------------------------------------------Depth of filter material--------.-- r------Total length---.___------"-.------- -----'t-------_--- Seepag Pit: Distance to nearest --------Distance f;r.fou gafion----1A--------Distance to nearest lot line,_,�F........... 'ts../ material -------- -_ S___,,, _g._,Size: Diameter____ ________.___.--------Depth-----UW_Ii. ,K Num of pits..----."".""""""-Lining mc Cesspool: Distance from nearest well-----------------Distance from foundation.:-❑ __'.'____-_�_._Lin ing material----- ---- -----------i!----------- Size: Diameter------ --------------------- ---------Depth-- ----------- -------------_---------------------Liquid Capacity------------------------1----gals. Privy. Distance from nearest well.""""..._"_-_-.--_.._.____.......... ....Distance from nearest building_"__._"_"_"__________________:_---___----Distance to nearest lot line----- -- ------- ----------------- ------------------ ------------------------------------------------------------------- -------- Remodeling and/or repairing (cleslbe):- - --- ------ i ------------------1_7 -------------- --------------------- ----------------- -- ---- ------------------------------ ----------------------- ---- i -------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- -- ---------------------I ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby c4fify that I havle pr;pared this application and that the work will be done'in accordance with San Joaquin County I- ordinances, State laws, and rples and regulations of the San.Joaquin Local Health District. 10 (signed}-------------- ... ........ . ........ ----------------- ---------------- ------------------------------------- -•------- -------- ,,e.(Owner and/or Contractor) ;.� ' zf��, BY=--------------------------- ------- ------------------------------------------------------•-----------------------{Title) ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be pl�r�_e�; reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.----- -------- ----------------- ------ DATE-------- ti-------------------------------A- ----------- REVIEWEDBY. -----------------------------•-- -- --D---A--T---E--------------------------------------------------- - ---------------------I --------------------------- - - BUILDING PERMIT ISSUED--------------k------------------ ----------- ----------------- -------------------- DATE ------------ Alterations and/or recommendafions:. ------- . -- - *---------------------- - ------------------------- --- ---- -----------------------------.-.-.-.-.-.-.-.--.-.-.-.-.-.-.- ...-..-.-.........-..-........- ---------------- --- ----- . - --- ........ _-/__7...-6......-.--T- --------------_---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------I-—------—-------------------------------------------------------------------------------------!I;- - ------------------------------ - - -------------- ---------------------------------------- ----------------- -�3 a j-------------- ------------------ FINAL INSPECTION BY:--- ---- -------- .. ----------------------------- Date------- --- -°------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street # 132 Sycamore Street 814 North "C" Street Stockton, California a Lodi. California Manteca, California Tracy, California ES---9-2M 145446 A7W6;I6 12-54