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/A� APPLICATION ?t�NGG FOR SANITATION PERMIT Permo. ..-4-J... ... I -LI (Complete in Duplicate) ! /......... a M Date Issued ------ ------- Applica+ion is hereby made,fo 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 OCATION_.._____ _ --__-No----- 1 Owner's Name-------e _z_ . --------_ ------------------ - --- ------------------- ---- . . Phone Address .. i �... - - ----- -------- ----•---------------------•----------------••----- -----••--------------••-------------- Contractor's Name...----- ------p( --------------------------- --------------------------------- Phone Installation will serve: , Residence R Apartment House ❑ Commercial Trailer Court _ _ ❑ ❑ Motel ❑ Other ❑ Number of livingunits: ----_ Number of bedrooms _..�vumber of baths ._/_-: Lot size _-_.--_- d__�__11�•_--_-- _ • �� Water Supply: Public.system A-,.Community system ❑ Private ❑ Depth to Water Table A, ft. Character of soil to a depfWof 3.feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe, Hardpan ❑`F Previous Application Made: Yes ❑ No 64-. New Construction: YesJ!K.No ❑ TYPE•OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept ic Tank:r •. Sep❑ Dist of tom n nearest well=--------- -------Distance from foundation--.-_.---- ------- -Material P -----------°---Size---------------------------------Liquid depth--------------------------- ------------------ --- Capacity-- Disposal Field' t tante from nearest welloff ---------------_Distance from foundation-----_-.---- Distance to nearest lot line_-..___-...___.._ ❑ um of lines------------- -'-Length Length of each line-------------:---------.•------Width of trench-------------- El Type of filter material---- _____--_.Depth of filter.material---------------- ----Total length------------------------------------------ 9 ---_.--.--.-____-:- _ - -------------------- Seepage Pit: Distance:to nearest well-._A4istance frofo ngat•on-_- . 15 ._...Distant ftp nearest loft line- Z-37._�__-_. i Number of pits------ -----------Lining material - g' Diameter_--- ._ .-.-__De to--- {. Cesspool: . Distance from nearest well `from foundation__.._..-._..--__-.. Lining.material-..-___._________-________._ --•------ El i Size: Diameter----'-- ---------------- -------.-Depth----------------------- ---- •-----Liquid Capacity-----------•------ . - - - - --------gals. Privy: Distance from nearest well-------------------- ----------Distance from nearest building Distance to nearest lot line.__---------------------------'--- --------- ----------- Remodeling - Remodeling and/or repairing (describe}:-------- -------------- ----- ------• •------------------------•- -----••-------------•----=-----•-------• ----------------------•---- -•--- - ------•- ------•-------- -•-----•------ ------------------------------------------------------------- ---------------------------------------•-----•-- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aw and rules and regulations of the San Joaquin Local Health District. (Signed)------- ----- ? ---- ••- -------'---------------(Owner and/or Contractor) BY. = (Title) ` ------- (Plot pian, showing size of lot, location of system in relation"to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY ------ DATE------- a------------ --------------------------------- BUILDING -------------------------------- BUILING E -- 'I -- E - ---- ----- ------------------------------------------- ---------- DATE--------------- ---------------------------------- i DING PERMIT ISSUED- ----------------- - DATE ` Aiterafions and/or recommendations:--.................. .. "" - ! r `r � ------- --- h ------- --------•----------- ---- �� ti --------------------•-----•----------'------ -----------------------•------- FINAL INSPECTION BY:.. --"-------------------`------ Date.....e�_ _ ------ 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--5 i4saas.wr waoo '