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APPLICATION FOR SANITATION' PERMIT Permit No. __1? (Complete in Duplicate) Date Issued Applica-lion is hereby made to the San Joaquin Local H.ealth 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 TION-:_" Z- ;7-- ---------- n�Z'5� ------------ --------I-------------------------------- ---------- Owner'Sr Name e ------------- ------------------- ------------ ------- Address-----------/ - --------------------- Phone. ------------------------ -------------------- ---------------------- --------••-•-------------------------------------- - Contractor's Name_--t-.11�2�_ ------- ----------_ -------------- ---- --------------------------------------------Phone Installation will serve: Residence Apartment House e [] Commercial '" "€ ❑ Trailer Court El Motel 0 Other ❑ Number of iving units. --/---- Number of bedrooms ate • _--.Z-Number of baths __/---- Lot size- ------- z Wafer Supply. Public system R�_Co' ----------------- ,MMUnify'SyStem Private [I Depth to Water Table 110(ld ft. Character of soil to a depth of 3 feet:[ Sand E] Gravel 0 Sandy Loam E] P Clay Loam E] Clay [:1 Adobe Hardpan E] Previous Application Made: Yes El No�New Construction: Yes._JE`No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- —Distance T❑ ank- ;nce from nearest we)l------------:_....Distance from foundation____________- ------. Material_' ------------- - N f compartments---------- -- ------------Size-------•------------------------Liquid depth----- ----------- ------------------------ f ---------I--------- P - Disosal Field, Dis ance from nearest well_________________-----Distance from foundation--------------------Distance to nearest lot line________________ El 2��ber of lines--------- -------------------------Length of each line------------- ---------.-------Width of trench Type of filter material____-___________________Depth of filter material___.____-____..___x __P-- ------------------------ - -Totl lgh----------------I------------------Seepage Pit: Distance to nearest �_ istanc roMrf LUMn ati n_____. r?------Distance 19— Number of pits m IF nearest lot line e,10 ....../T -----------Lining aferi __!5�--- ----- ------ Cesspook --- ------------ Distance from nearest well__.________.___Dista from ation-- -- --------------Lining material________._._________---.-Size:-Diameter.----------------- --------------------Depth------ -------------------- ---------------- -------- -------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest Weil___-_____________________-----------------------Distance from(nearest building❑ "Distance -.--------------------------------------- to nearest lot line________________------------ ------------------------------------I——------------------------------------------------- Ilk Remodeling and/or repairing (describe):_____.._---_---_---_------------------------------------------------ - ------------------------------------------ ---------------------- -------------------- ------------------------------------------------------------------------------------------------------------------------------------------ i -------- -----------------------_---------------------------- ------------------------ ------------ --------- -------------------------------------------------------------------------------------------------r----------------------- ----------------- ----------------------------------- nc Lm from - --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I here6y, cerfif at I have,prepared this application.and that the work will be done in accordance with San Joaquin County ordinances, Sfat aws land rules and regulations of the San Joaquin Local Health District. (Signed)•----- --- ---- -- ---------------------------------------------------------------(Owner and/or Contractor) 1�4. ..... 7--, -- - --- -- --- -----..(Title)------e w--—------------------------------------ (Plot plan;`showing size of lot, location of sysfem.in relation to wells, buildings, etc., can beplaced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY____.__.____________________--------- REVIEWEDBY -- ------- --------------------------------------------- DATE---------- ---------------------------------------------- ---------- BUILDING PERMIT ISSUED------------_- -------------I------- ---------------------------------------- DATE------ -------------------------------------------- Alterations and/or, recomnr�endatiops:----------------- ------------------------------------------------------- DATE------------ ---------------------- ------------------_-----•-------------------------------- - S-7------------- ------ -------------------•--- -------------------- --------- - - ------------ ----------------------------------- ------------------------------------ ----------- --- ---- ------------- ---------------- - -- ---------- -- - ----- --------------- ----------- - ------------------ -------------------------------- ---------------------------------- -------- ------------------------- --------- ----------------------------- -------------------------------- ......... - ------------------------------I----------------------I----------- FINAL INSPECTION BY:______: Date.------------ -- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street - LoJi, California Manteca, California Tracy, California ES---9-2M 1-446 ATWboo 12-4