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� APPLICATION FOR SANITATION PERMIT Permit No. __.._IlI_.�!--_�. . . n (Complete in Duplicate) Date Issued / //-�5 Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install +he work herein described. This application is made in compliance with County Ord' e No. 549. JOB ADDRESS ANLOCAIION_ r_�_�_._ .. _--_ _ _ L- � - --.--------------- - ------- � Owner's Na a------------------------- ` - --------- Phone , .Address: ..__ ? �-- < ------i - ` 4_vig-------------_-------- ----------------------- Contractor`s Name G��-� p-- Phone -- ._ Installation will serve: Residence-WP'Apartment House ❑ Commercial (] Trailer Court ❑ Motel W;10"ther ❑ Number of living units: Number of bedrooms -_�-_ Number of baths _ ___ Lot size --��_.' Y�.--- -CIO_ ____------ ____ Water Supply: Public system ] Community system ❑ Private Depth to Water Table _XVft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E-] Sandy Loam El Clay Loam F] Clay C] Adobe�ardpan E]Previous Application Made: Yes E] No L� New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 7 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic TonDistance from nearest well_,@---Distance from foundation-r__.--_- -.Material-______________________________._--____.___._. No. of compartments--------------------------size---.----------------------------Liquid depth------------------------------------Capacity---------------------- osal j ieId: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------------------------------Wid#h of french----------------------------------- I Type of filter material------------------ -----Depth of filter material-----.------------_----Total length--------------------------------------- Number of its_____ __________ f undation_ �_�.__.Dis nce to nearest lot line_ Seepage Distance #o nearest welLQ�,�_ Distanc� rom • F y p" ------Lining material_d,�-----Size: Diameter_.-- f!----DepthI.RQ_�----------------- S. � Cesspool: Distance from nearest well-----------------Distance from foundation--------------------L`ining material---------------------__________-_____. d ❑ Size: Diameter------------------------------------- Depth---v-----------------•------------------------------Liquid Capacity --------------------------gals. Privy: Distance from nearest well------ ______________________________Distance from nearest building-------------------------- --------- 4�jr ❑ Distance to nearest lot line---------=------------------- --------------- - ••---~------------------•-------------------------------------------- N 011 Remodeling and/or repairing (describe):------------------- ---------------------------- ...--•------------___ •--------•---------------------------------------^•------•-----`� ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------- I eby c rtify that have prepay this a p cation and t a+ the work will be do a in accordance with San Joaquin County ordinances, S d rulesland r lations the San J uin Local Health Di rict. -- -- ---------------- ------------- ------ ---------- --- ------------------------- (Signed)---.----.. . ! Contractor) ------------------------- By:-------------------------------------------------------------------------- --- --------- - --- ----------- - -------(Ti+le)__ �- --..---- ----------- (Plot plan, showing size of lot, location of system in r ation t we Ridings, et ., can be placed on reverse side). F6&DeARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------ ---- -- ----------------`--------------------------------------- DATE---------------------- REVIEWED BY------------------- ------------------------- - --- ----- ------------------------------•------------------------ DATE------ BUILDING PERMIT ISSUED----------------------------- ---- ---------------------------------------------------------- DATE--------NN- Alterations and/or recommendations----------------------- -- ------ .. ------- -----------------------------------------------------•------------ _ ------------- - ------ - --------------------------------------- •--------------•--•---------------------•-•------------ == D.. '!Zx_G L FINAL INSPECTION BY:------ ----- --------------------------------- Date--.-j2 `-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Nortif "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES�9-2M 145446 ATW000 12-54