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APPLICATION FOR SANITATION' PERMIT Permit No. --- l_----.---- "- �� (Complete in Duplicate) Date Issued .1i _---__ V 4L.L e4e� ppliceion is he made to the San Joaquin Local Health District for a permit to construc and install the work herein described. This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND L TION . __ _ ,--_-. _______ , ---- ---- -------------------------•-------•----- ------• --_.....--.----/------ Owner's Name-------- ---: -- f�� ------------ --------- -------- ---'------- -- --- P ne- Address---- --- ------ -- (/'� �-- - ---- _- r ---------C Contractdr's Name'_ - :..--•- ----=- hA e - Installation will serve: Resi enceApartment House ❑ Commercial ❑ Trailer Court ff"Mo e Other ❑ Number of living units: -- ----- Number of bedrooms Number of baths l.____ Lot.size __ ..— ._ _. .. ____________________ Water Supply: Public system ❑ Community system ❑ Private \\ Depth to Water Table-;Z,-&,-�)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.) eptic T k: Distance from nearest well_________________Distance from foundation,-----------.-------Material________--____----_________________-__.________. No. of compartments-------------------------Size-------------------'--------...Liquid depth--------------------------Capacity----------------------- Disposal Fie Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line______-_______-__ Number of lines-------------------=--------------Length of each line------------------------------Width of trench----------------------------------- Type p rial-----------�------Total length--------- --------Seepage it: Distanceftl�e� mast Iwellj��, 7-- D sta�.�To�ation__,�____. ..___.Distance to nearest lotNumber of its____ ____p g mat ria Size: Diameter•---� •-----------Depth--7 Cesspool: Distance from nearest well--------- Dis undation---_----------------Lining material----------------- Size: Diameter-------------------------------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------.-------------Distance from nearest building-------------.-------------------w____._. ❑ Distance to nearest lot line---- ----------- --•-------------••---•---------------------------•-------------------- r1 Remod and/or repairing d -escribe :._ ----------- - -- ••------------------ --- / � --------------------------------•------------------------------------------------------------------ ---- ---------------------•--- --------------------------------•------------------------------------ ------------------------------------- -------------------- -------------------------------------- hereby certi hat I have prepared this application and that the work will be done in accordance with San Joaquin County rdinances, S aws, and r a regulations the San Joaquin Local Health District. Owner and/or Contractor (Signed)------ - -------- --- ---------- ------------------- I I By:---------------------------------- -A. ---------------------------------------------------------------- -----{Title `"' '"._ - ------------- (Plot plan, showing size of I , Iocati n of system in relation to wells, buildings, etc., can be p a ed on revs side]. FOR DEPARTMENT USE ONLY '"'—"'""'"�—•_••__._._.._._._.._.._ ..-._.._._.__ APPLICATIONACCEPTED BY -------------------------------------------------------------------------------------------- DAT E----------------------------------------------------- REVIEWEDBY---------------------- -- ----------------- ------------------------------------- - DATE -�-r BUILDING PERMIT ISSUED --------------- =--------- ._. DATE----------- - __ Aiterafl ns and/or recommendationssA---------- . r------------I ----------------------- - --- - .....---------------------------------. - ...-+ 1 -----------------------------------•------ ----------'t------------I �- -----'LM--1`-------• - # . J(yi --------------------------------- --•----------------- --•----- . i ------------------------------------------------ -------------- ----------- • r a CS FINAL INSPECTION BY:------- r-------------------------•--- Date------ --------------------------------------------- --------------------- SAN - ----- 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 E5-4--2M ; Revised W-2100