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APPLICATION FOR SANITATION PERMIT Permit No. -te _________ (Complete in Duplicate) Date Issued ___�� Applicaa-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 Ordinanc . 544. JOB ADDRESS AN -- -----------(/ 6 -C _�c �LON____ - � Owner's Name__- --_ -Q_- -- •---------- ----------------------------------------- ----------- Phone-.-. ---------------- ------------------------ Address__ :- -__ ' __________________ ________y---------.-____________-___---______________--________-_______-___-________ ______.._____._______.. Contractor's Name__ ,_---_ _ _ " -- -- ---------- ------ ------------•--- Ph on - - Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Moral ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths _ Lot size ......21 ----------------- Water ----- -Water Supply: Public system ❑ Community system t Private .Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand E] - Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No A--New Construction: Yes ❑ No ]—� TYPE OF INSTALLATION`AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic _: Distance from nearest well-----------------Distance from foundation--------------------Material-___--_____-_-__--_____-____-_____--_-----_-__. J-, No. of compartments---_-----------------.- Size------------------------- ------Liquid depth--------- -- -------------Capacity....................... Disposal Field: Distance from nearest we V6 0_.':.-Distance from foundation__/011 '-----Distance to nearest lot line---70 Number of lines---------- -- ax -.__--._.Width of trench----- Z_.�("---------------- -,_-- Length of each line______:____ 7',� .? p Type of filter material__- __. -. De th of filter material____- _. ......Total length___-___ _&. --- ------------------- feria Pit: Distance to nearest well_/S�Q--____Distance om foundation__ __•_.Distance to nearest lot line---Sor p f _____________Lining material_ r -_ ., Diameter_ Number of its-.-.- - - ---- cize: �'r. Deptl-s_.-. � Cesspool: Distance from nearest well-------- ---------Distance from foundation--------------- Lining materia!______ _ _ ____________-._-_______ _ ___. Privy: Distance from nearest ❑ Size: Diameter � ---- - = -well----------- -------Depth---==y----=--==-----------,�--------------------Liquid Capacity------ ---------------- gals. _.-. ___________ ----------------------------------Distance from nearest building----------_----------------__----- Ej Distance to nearest lot line-------------------------- ----------------- Remodeling and/or repairing (describe):-- ---------------------- -----------------------------••------------•-----•--•---------- --------------------------------- -------- ---------•-------------- ------------ ----------•--------------------------__------------------------•-•-------- -----•----••-------------------- ---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, la , and s and r guiations o the San Joaquin Local Health District. (Signed)-- - -- -- - ------ .----- --- ---------------- ontract ) t rC or Sy:-- -- -'--- "-r----------- (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------- REVIEWED BY DATE.... ---•----------- -------------------------------- ---------- --------------------------- -------------------------r....... DA t- BUILDING PERMIT ISSUED---------------------------------- ---- ------------------------------------- -------------------. DATE---- ------------ - -- I Alterations and/or recommendations;------------------- __ -------------•-•---- -•-------••-- •••-----------------------•-------- --------------------------------------------------------• ----------------- 1 -----•------------------------------------I- --------------•- - ---- ------ --------------- ----------------------------- �-- FINAL INSPECTION BY:........ '"""` _ ------------------ Date--------- 7-` 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 145446 A7WO9D 12-54