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APPLICATION FOR SANITATION PERMIT Permit Na...... (Complete in Duplicate) / �~ r Date.Issue "r•. ----•-- 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 Or/dn No. 549. ; V . JOB ADDRESS AND OCATION -�- - �ll. . -- ---- ,, - IAZOwner's Name •✓% ---- Phone Address- -------.... -•-----�---_ - -----------------------------•--•------------'------------------------------------------ --------------........ -. Contractor's Name........... � �� -� OM1.. Phone .� �. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ..... Number of bedrooms_/_'. Number of baths .___ Lot size _ d -------------------------- Water Supply: Pub4ic system . Community system ❑ Private ❑ Depth to Water Table ft. Character of soil fo a depth of 3 feet: `Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe Hardpan [j Previous Application Made: Yes ❑ N� ❑ New Construction: Yes '` No � TYPE .OF INSTALLATION AND SPEC Fl (CATIONS: ,�• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) l Septic Tank- Distance from nearest well--------!--------Distance from foundation------------------Material--..__ ---7`_,-___- .- -`---_ :A.. No..of-compartments------------- :_Size--------------------------------Liquid depth----------- _-----�--Capacity-------------:--------- I Dispo field: Distance from nearest well------_ _ Distance from foundation...................Distance to nearest lot line....-...__.-..._. • .x�1 Number of lines---------------------m."---------Length of ee*h- rr --? Width of trench----------------------------------- Type of filter material-------A----I Depfh'o�filter mZat;L t`�I----------------------Total length-----------_--------------------.--------- , Seepage Pit: Distance to nearest well. --------D+stance ori f ___,� _._..._..Distance to nearest lot line--- -----�. Number of its.... - LiniL-Depth al. _Si e: Diameter-.-...?.............De fh----_ °... _. . yam' p p J` ` _ Cesspool: Distance from nearest well ance fr_ -Fo dation..............:.....Lining material_..........: .. ❑1 Size: Diameter---•-- ------------------ --- ----------- -------- ------------- -------- ------Liquid Capacity--------------- ----- gals. Privy: Distance from nearest well-------- - -----_---------------=--Distance from nearest building-----------------------------------------. ' ❑ . . ., _. Distanceto nearest lot line �--------------------------------------- ---------------------- --------------------------------------------- Remo ling and/or repairi (describe}:_... _ . �.._ , _- :.__ '°- -�� i !f`�r ------------- ! - hereby certify--- I have prepared this applicnatioand +ha........ +hw e ork will be done in accordance with San Joaquin County ' ordinances, State laws,' lad r es and regulations of the San Joaquin Local Health District. -I' Si d (Owner and/or Contractor) ----Title f'�----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can.be plae€d on reverse side). F i y FOR DEPARTMENT USE ONLY ll APPLICATION ACCEPTED By" Y l ----------------------------------------------------- BUILDING ------• . - �--------------------- 'DATE-- - .--------___------------------------------------------- REVIEWED - ---- -----------------•----- --------- REVIEWED BY----------------------- - DATE-----: ------•------------- ----------------------------- ------------------------------- PERMITISSUED- -------_-------------------------- ------------------=---E----=-------------------- DATE-------- Alte ions and/or recoiinmendations:----b It ,. „ - +3 4 c -- ---- 4yx-1 X, -- ----- ------ -- j ---------------- 0 FINAL INSPECTION BY:.. - Date .: j- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amariean Street l 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, 'California Manteca, California Tracy, California ES-9-2M Revised W-2100 +