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� APPLICATION FOR SANITATION PERMIT permit No. --- -----------•- "1 �. (Complete in Duplicate) Date Issued ____��._ kv to the San Joaquin Local Health District for a permit to construct and install the work herein described. Applica+ion is hereby made This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_.___.__.- -- - - ---------------•------------------------------------------------- Phone Owner s Name___"__ ------- --- -- - Address------- ••--r----• -------- --- -- one 10 7.- .-. � -- Contractor's Name.---�--•---- ------ -- ----- • ----�---- -- �-- ----------------- ins+allation will serve: ;Residence Apartment House .❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ rooms _Number of baths __!- Lot size � _.�d ------------------------ Number of living units: J.---- Number of bed Water Supply: Public system Q--Community system ❑ private ❑ Depth to Water Table_�Zi- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeE�Hardpan ❑ Previous Application Made: Yes ❑ No 5, New Construction: Yes �No El f TYPE OF INSTALLATION AND .SPECIFICATIONS: (No septic tank.or cesspool permitted if public sewer is available within 200 feet.} Septic Tank: Distance from nearest well ______________Distance from foundation-------------------- --i-- de th- Material--__------C--�acity----------------------- 'foundation ____..__________.____ ❑ . f compartments-- ----------------Size--------------- q p. ---Distance Disposal Field: • Distance from nearest well-.__.-------- _Distance sanofeom achline ation_.--" _ Width ofttrench est lot line ❑ er•of lines---------------- Length Ty of filter material---------------- -------Depth of filter material -------------- ---- --Total length---.---------------------------- p ! �V Seepage Pit: Distance to nearest'well_"_ d rix..—Distance from founa 'on----- Distance�e to nearest l --- Number of pits..-.-.-t.-.---------Lining materia��'-"l�YZe Diameter_-.- 3- k --- - •fm Distance from foundation-------------------lining materiapl_ -.____.-_.__.__.-._____---------- GJ ----------- Cesspool: Distance . Depth _Li Liquid Capacity gals. Size: Diameter------------------ ------- Distance from nearest well-------------------------------------------------Distance from nearest building-.-------------.-------------------------- Privy: Distance to nearest lot ine-------- ------- --- -- --------- ------- ---------------- ---------------------------- ❑ • -----------------------------------•------------------•---------------------------- Remodling and/or repairing (describe)--------------------:----- --- -•---•---•----------------------------------- ---------------- - ------------------------------------- ---- --------- --- - that e work I hereby certifa that dha have pandaregulatona application the San t Joaquin Local Heal1 heDistri�}n accordance with San Joaquin County ordinances. S e �_., C~ _ -------------------------------------------------------- -----„[Owner and/or Contractor) Si ned ,��'�_"(J deo ��- - (Title)----- --- --- �-=--�-------------------------- dings, ------------- ----- By:. (Plot plan, showing sire of to+, location of system in rale+ion to welts, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - -------- --------- ---------- ------ DATE.---- ,�--- i APPLICATION ACCEPTED BY--- ---------- -------- ------- -- -- "'� . �”�-- -�----- --�-�---- -� ----- ----•---� --------- --- DATE------ ----------------------------------------------------- REVIEWED BY----- ----------------------------- -------- ----- - ----------- ----; DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------- ---•--------------------- Alterations and/or recommendations:.----------------------- -------- ------------ r I --- —' ------------------------ --e------------------------------------ -------- -------- ------------- --------------- ---------------------------------- ---- ----------------------- ------- Date.. 0 -'" ---------------- FINAL INSPECTION-BY:__-- 6 -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT no West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Lodi, California Manteca, California y'Trac California Stockton, California ES_9-2M 145446 PTWOOO 12-54