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rld-,e) APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ► � This Permit Expires 1 Year From Date Issued Application is hereby made oto 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 Owner s Name----------- A - Phone. Address--------- - -----------I� ------•-----------------------------------------------------------••-----------------=-----•----------•- ------- Contractor's Name .' Phone --- Installation will serve: Residence [Apartment House F1 Commercial ❑ Trailer Court ❑ Motel ❑ Other 114 .{ i�. Number of living units: J--- Number of bedrooms -Amt- Number of baths __f--- Lot size 1-4��' --••------ . E3Commuriity system El Private Depth to Water Table /' ft. Water Supply: Publicfsystem Character of soil to a depthof 3 feet: Sand ❑ Gravel F1Sandy Loam C] Clay Loam ❑ Clay [I Adobe ardpan ❑ i `� ��,RRR""Previous Application Made: Yes [g No New Construction: Yes ❑�' No FI iA/VA: Yes ❑ No RR--" TYPE OF INSTALLATION AND SPECIFICATIONS: F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tarr Distance from nearest well__�.-______:_Distance from foundation___-__.______.__---Material______________________________________________. 1 � 'r"�' �� p ------------------- Size ----------=-- Liquid dep#h Capacity � � No. of com compartments...... � .� , Disposal Field: Distance from nearest eil- f .__...Distance from foundation__--IQ--_-_-___Distance to nearest lot line-47_______ P ---. Length•of ei�ch ----------------Width of trench----1 _1�� -----•---------------•-- Number; of lines_________ ____ _ s Type ofrfilter material_ Depthof filter material__ _ -------Total length____ ---------------------- Seepage Pit: Distance to nearest well---------------------- from foundation-------------------Distance to nearest lot line-------.-------- O ❑ Number of pits----------------------Lining material:---------- m-'Size: Diameter---------- - ---Depth- --------------------------- v I � » Cesspool: Distance from nearest well----------------- from foundation-------------------.Lining material------------------------------------ -------- ------------- ---- Liquid Capacity ------------------ g ❑ Size: Diameter--- --= Depth- -------- `-------- --------------- - � Privy: Distanc1 from nearest well-__-'_._________________________________________Distance from nearest building__._.___---____________---__.___-.__-.. ❑ Distance to nearest lot line= _°_T ---------•----------------- --•---------------------- ----- or r Remodeling and/or repairing (describe):------ e------------ I�i - -------- ------------------------------- IM. ' -------------------------------------------------------- ----- ------------- IM ' --- --- ----- --------------•--------------------- I hereby certify that Ithave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 �,,'lslff P/ �-�---�.,..— ---- Contractor) Si ned _ = �"` _ -=-----= -------- _ = -------------------- ----[ g ] By----------------------•----I---------------- --- ------------------------------ etc a(Title) ac '� �. to wells buildin s, ., c n pl ed on reverse side). (Plot plan, showing size of jlot, IOcati system'in relation 9 FOR DEPARTMENT USE ONLY M APPLICATION ACCEPTED BY------------ --- - - ----- ----- -- ----------- DATE- REVIEWEDBY------------------- --------------------------------------------------- DATE--------- -------- --------------------------------------- BUILDING PERMIT ISSUEb ------------------ DATE------------------------------------------------------------ ------------------------------------------------- Alterations and/or recommendations:.-----__�_-1_.__----------------- ------ ------------------------------------------- M ---------- --- ------------------------ ----------------------•-------------------------------------------------------------------------- - - I :` --- ----------•----------------------------•------------------• -------------------------- - ---------------------- -------- -------------------------------------------------- ---------- --- ---------------------- ---------- - 11 f FINAL INSPECTION BY.-------�--------- Date LSA (W SAN JOAQUIN LOCAL HEALTH DISTRICT j - 132 Sycamore Street 814 North "C" Street 130 South American Street 300 West Oak Street «�_ Y , Lodi, California """` Manteca, California Tracy, California Stockton, California 15.9-2M Rev e.d 6-'59 F.P.Co.