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�l APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) _ Date- Issued Applica4-ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549. a JOB ADDRESS AND LOCATION--- > A. •r�-1 -- ----- ---------------------------------- Owner's Name---- ---- ==_......-�L✓ -----------------•---------------•-- h e s _= _ . Addresst>. t ----------•-------------------'----------------------------------------;------------------ ` ---- W_Contractor's Name----- -=---- -------------------------- ------------' Phone 7"_'11- ' Fa Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer ICourt ❑ Mofel ❑ Other ❑ ` Number of livingunits: _ Number of /._ bedrooms _/_- Number of baths -, Lotrsize _____+--- -�__. �e�A_______-._-__-______ Water-Supply: Public system . Cornmunity system ❑ Private ❑ Depth'to`Water Table 4a-ff. s Character of soil to-a depth-of 3 feet:+•Sand ❑"Gravel ❑ Sa dy Loam ❑ Clay Learn ❑ ! Clay ❑ Adobe Hardpan 0 Previous Application Made: Yes ❑ No!, New Construction: Yes No ❑ ��. r I I TYPE OF INSTALLATION_'AND�SPECIFICATIONS: • �M (No septic tank or cesspool permitted if public sewer is available within'200 feet.) ; Septic Tank: Distance from nearest well -_ _`Distance from foundation------------ Material--------_ ------------------------------------------ Q , No. of compartments ._t --- Size- --------------------- --Liquid depth _- ---- Capacity-.--------_------------ O Disposal Field: Distance from nearest well..Ap.. Distance from foundation_____ _._ ._ ___:_.Distance to nearest lot line____ _________ 0. Number of lines --- - - - -=•_• . Width-of trench.. _._2_q-r'_......_______.. N i € ff Type o� filter material -t'.__ ____ Depth off f lte h mlatenal____.I.4.'--L._Total length______W__4'__.______________________ w .� Seepage Pit: Distance to nearest,well..._~�___�___-Distance from foundation .Dis#ante to nearest lot line_________________ ❑ Number of pits__- #-------------Lining material------------------------.Size: Diameterf -------- "Depth -------- ----------------- Distance from nearest well_____:________-_Distance from foundation material:__----.___--..-_--_-_--_-_________. Cesspool: _ " ❑ ; - Size:-Diameter----€ ---------'-------- Depth------------------- --------- ------- t -Liquid Capacity-------------------------:----gals. Priv 1 Distance to n areat�lot-line--- ---------------------------l � °` ,,._. . Distance from �ea�est b-M-- -..�g.�__________________ I Privy: -----' ❑ - ------------ - --- --- -- ------------------------------------. ------ -------------- b' -- -------- � �� ---- ----- -- -- - Remodeling and/or repairing (descri Vie]:_=___ ______ ___________________�__-_ - ---•------•- - �+ --------- ------ ,. - - .. = - - ---- ------------ -- :- - - - ------------- 1 ---------------------------------------------- - - ------------- :---------------------------------------------------------- Ih hereby c tify'that I have pr pared this application'arid that the work will-be done'in accordance with San Joaquin County ordinances, State I ws,"and rules and regulations of the San'Joaquin Local Health District. r1 y (Signed)------- `., �t, -----------------'- d----=----- _(Owpr and/or Contractor) Ian. showing lot, locationrelation to.well- -------------- ---- (Title)-- _ __ --- --- • -' ------•---- --------.'- (Plot P g s,'buildings, etc., can be placed on reverse side). g FOR DEPARTMENT USE ONLY: APPLICATION ACCEPTED BY '_=#- =-=-"--- ---=_---= "�"__= .------_--- DP�TE_z-� --zl --------------------- ---------------------------- REVIEWED BY---------------------- ------- '-- '_. .. DATE _, BUILDING PERMIT ISSUED---------=-=- ------------------------- ---•-----------------------------------------------------•-- DATE----- 4s r Alterations and/or recommendations--------------------------------------------------------------------_----- ----------- ------- •---------------•--•- ._-f,-.-• --------------------------------------------------••---------------� -----"'-------•.------------------......_.._-------_._------------------------------- -- l --. 1 m Y _ �. --Date ------------------------------- ---- FINAL INSPECTION BY:_ ---- --_°'` ti SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South+American Street 300 West Oak Street 13iSycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-21v1 Revised W-2100