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APPLICATION FOR SANITATIO N PERMIT Permit No. ---O_...-_AU v- y (Complete in Duplicate) Date Issued Application 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 - rdinance No. 549. JOB ADDRESS AMD LOCATION--- ""�+�� ,ter y - - -- -------•------------------------ Owner's Name ___ ./lif ' f � f"��' ------•------------------------------------------------------------------- - Phone--------------- �✓ Address--------- ►d Contractor's Name---_. i -------- -- ---------- - -- ---- -------------------- Phone------ Installation will serve: Resi Apartment House Commercial ❑ Trailer Court El Motel ElOther ❑ '"` Number of living units: _- ,Number of bedrooms __4-_ Number of baths -Z-- Lot size -----1-rry�49-_�_ Water Supply: Public system Community system .❑ Private ❑ .Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand,❑ Gravel E] Sandy Loam Clay Loam lay E] Adobe ❑ Hardpan El Previous Application Made: Yes E] No Or. New Construction: Yes © No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if7ublic//ssewer is available within 200 feet.) Septic 'ank: Distance from nearest well (.__-Distance from foundationla)-Mate 'al-- �" ne V No. of compartments-----=-----------f --__Size*'- . 4Liquiddth--------- r_ _ /Q �---- , - -----Capacity------- Dispo�gf Field: Distance from nearest we i'._- isfance from foundatiorL_!`S,__t__�_rD„stt to nearest fpf li�ne_C5_lul r' M Number of lines---------- °�-_---Length of each line.,30,-a5�W.______.__TofaI S d �Gi th of trench ---------------- T e of filter materi ,Yp ' Depth of filter material___- _ length---------I------lam r--__ U Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material---_-_-_----__-------Size. Diameter_----_--__----_ Depth �k •------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_----_-_-_------_-__El ._-_______ �V Size: Diameter--------------------------------------Depth---- ------------------------------ ---------Liquid Capacity---------•-----------------gals. Privy_: Distance from nearest well--_-----------------_-- r ----_---- Distance from nearest building ❑ Distance to nearest lot line ----------------------- l Remodeling and/or repairing (describe)----------------------------------------------------------- ----•-------•------•-••-----------------------------------------------•--------••--- ----------------------------------------- -•------------•------------------- , ------------------------------------------------•------------------------------------------ ----•-----------------•------------------•---------------•----- ------------------------------------ w%'�------ I hereby certify that I have 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 Joaq'uin Local Health District. (Signed)_rt:------------------------ --------------- - - --------------------------------------------------------------------- -------------------------(Owner and/or Contractor) By:---------------------------------------------- ' ------- - - --- ----- - - - -- -- ----------- -------------- -- -(Title)------------------ -- -- -- - - - ------------------------------------ (Plot plan, showing size of lot, location of sys et m in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY +�T. APPLICATION ACCEPTED BY2._ ------------------------------------ DATta ----------------------- REVIEWED BY - ------------- ------------- -- ------------------------------------------ DAT✓"---- ^'� -------------- I -------------------------------- BUILDING PERMIT 155UED--------•------ - ------ ------------- DATE----- ___4-------------------------------------------------- -A Alterations and/or recommendstines---------------------- -------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --•---------------------------- FINAL INSPECTION BY:- ----- ---------- Date--------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100