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APPLICATION FOR SANITATION PERMIT Permit No. ... .1_.__... (Complete in Duplicate) / el /� Date Issued _---__- 6...` . Applica+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. JOB ADDRESS AND LOCATION__________ _ ____ ------------ -_--__- oa► Owner's N _4 --- -------- - --- - -- ----•---- - ----- Phone ` Address__... Contractor's Name------Q!tJV------ •. -- -•----------------------------------•-------------------------------•-------------- -----. Phone Installation will serve: Residence El Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ........ Number of baths-------- Lot size Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tkk: q Distance from nearest well__,_ ... _____________Distance from foundation•__--__ ___---__.Materia.................. . --_.--__-----__.- __----. - � S 1 No. of compartments-.------------------------Size--------------------------------Liquid depth--------------------------Capacity---------- Disposal Fie , Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. umber of lines-----------------------------------Length of each line---------.--------------------Width of french Type of filter material-------- Depth of filter material------------------ length................................. i eepa Pit: Distance to nearest well---1__l?.0.....Distanc from foundatio _...1.._0----_-_-.Distance to nearest lot line-_._.__-_---• Number of pits.....--1-------------Lining material- 0-a_ JZ£ i ��........Depth--------r iameter_._.. _ � Cesspool: Distance from nearest well________________Distance from foundation --._ -__.Lining material------------------------------------- 171 -_ ._❑ Size: Diameter--- -------------- ----- -------Depth----------- ----------------- ---------------------Liquid Capacity gals. Privy: Distance from nearest well......... ---------------------------. _.-_--Distance from nearest building - -- " ❑ Distance to nearest lot line-- -- ----- Reelfin and/or re iri describe):.___�exGC�� - 9 - .. . ............ --•- . --'- -------- I...................il ,_m ____•- ...__..._ __ r_......... ..................................... . ...T7-.0........................ ..................................................... -. _____________ _________________ ______ ________________________________________________________________________ I hereby certify that I have prepared this application and that th work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. (Signed)------------ ------------ -- -------- ---- --- ..... - ------------(Owner and/or Contractor) By:......... a --------------- - -? ---- Tale ( � ) ------------------------------------------- (Plot plan, showing size of lot, location f system in lation to wells, bu' ings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --- --- ------------------ ----------_.._ DATE -------- REVIEWED BY --------------------------- -------------------------- --------------------------------- DATE--------- -•-- f BUILDING PERMIT ISSUED------------_---------------- ------ •• •--•••-•----------- --- DATE------------------------------- Alterations and/or recommendations:----------------------------- .._ -------------•-•-- {-- - ---------- - ---------- ------------- ----- - - FINAL INSPECTION �BY:_...... ... . r��-•----------------•-------•-•--•--- Date.--- ---- a'` 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 ES-9 145446 ATWDDD