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APPLICATION FOR SANITATION PERMIT Permit No. ._. 5�_Z_ _ (Complete in Duplicate) Data Issued .... 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.. ." _�lru0 — - - - - - P . Owner's Name------W,_..-P--= —7 / - - - -- ----------------------------- ------ - - - - --------- ---------- --------- - - ------ ---------- - ............ ---- - Contractor's Name....... ........... -- - - ------------------------------------------`-. Phone--`-------- ---`-----' - Installation will serve: Residence E]' Apartmenf House Commercial ❑ Trailer Court ❑ Motel ❑`, Other ❑ Number of living units: _1__" Number of bedrooms . .. Number of baths y 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 p No�ew Construction: Ye No ❑ \ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.){ Sa tic Tank: Distance from nearest well .a )LR.-Distance from foundation__.'0---...__Material_... __----- . ._. ---- No. of com artments.._. -- P - -----_ _ �5---�/C Liquid depth-------q-------------Capacity...._ ..A. Disposal Field: Distance from nearest well.y� Distance from foundation... .. `tel-aR. ) ......_....Distance to nearest lot line.... .........R9\ - - Number of lines...._.�� :._:.... L th of Fac line._.�U._qWidth of trench.Z . Type of filter materials.'t- 1.0 15"GTr O r material.._1. lS_. _-Total length__-._1_ - a-- Seepage Pit: Distance to nearest well_------------ ---._.-Dis+an a from foundation----------......_..Distance to nearest lot line...._._.._.__._. ❑ Number of Pits..._-....__------..Lining material.: _.....___...Size: Diameter-----------------------Dept h..... _ _ _..._ _ _..__. ..... _- - Cesspool: Distance from nearest well__...__._._.._ ` r {oundation___..__...._._Lining material_ 12 ❑ Size: Diameter.--- ---- - ' = - _----------Liquid Capacity--- ..............gals. Privy: Distance from nearest well_ istance, from nearest building.. �1 Distance to nearest lot line ---- \ Remodeling and/or repairing (describe):...__ -- - _--------- --------- - - -- - Jv - ?- - ----------_--------------- -- --------------------------------------------------------------------- - - hereby certify that I have prepared this application and +he+ the work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules andregulationsof the San Joaquin Local Health District. (Signed) .____ .................. (Owner and/or Contractor) By:....................... -------------_----_------------------------ ------- - -------------------- ----------(Title)--------------- .._...._ --------- (Plot plan, 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_ .. - ' ---------------------------------- DAT -----_> - - - - -- REVIEWEDBY--------------------------------- - - --- ----------------- .... - DATE - BUILDING PERMIT ISSUED-------------------- - ----------------------------------------._,....... DATE.--------- ... -- — -- - Alterations and/or recommendations:._..."__..._...... .. .. .. .......... . .._. _ __- --- ---- - ------------ - ------ ---- 1��- . --------------- - ----------- >-------- - ---------------------_--- ------------- ------ .........------- - -- - - - - --------------- �- - .... - - .......... - -------- ------- ----------------- FINALINSPECTION BY: - ------------------ .......------------ Date...__........ ...------ --..._--------------------------.._..--------- 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 2M 14a .Ai WOO. 12- 4