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r APPLICATEON FOR SANITATION PERMIT Permit No. . _ ............ (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 Ordinance No. 549.- --- ---------- JOB ADDRESS ANq LOCATION_---:-- Owner's Name Alo --------- -- ------ -- ----- ---- ------- -- e --- Address + ^• ------------ Contractor's Name-------- - '�!!Vl9li-- ----'---------------- Installation will serve: Residence$ Apartment House ❑ Commercial ❑ Trailer Court Motel [_1 Other PNumber of living units: __�.____ Number of bedrooms _. Number of baths ' t size __ ____l _ ------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan r P ❑ ❑ Y ❑ Y ❑ Y ❑ P ❑ Previous Application Made: Yes ❑ Nomjgf New Construction: Yes No ❑ PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) (�1 p . _ rom f ndation__._�._Q_-_------.Material----_\��-- ----- ---------- Septic Tank: Distance from nearest well___ _ istance'�f No. of compartments_-_____ a�__ Size____ Liquid de th________ ________......__Ca __ _ ____ q p. Capacity---- No. Disposal Field: Distance from nearest well------��l�istan%erom founelation.",A-Q_'__ Distance to nearest lot link,-�k-________ Number of lines---,-_______ _____ ____Length of each line____�_�}_ ___________.Width of trench.______ _ nV Type of filter material___ �_ h of filter material____.__ ____--___Total €ength___ _ '_�__ __ _____ Seepage Pit: Distance to nearest well-------------- Distance from foundation---------------------Distance to nearest lot line__._______.____._ ❑ Number of pits----------------------Lining material-------- -------Size: rbiameter-----------------------Depth___-_--__-__________-_-___------ Cesspool: Distance from nearest well------------------Distance-from foundation---_----------------Lining'material----------------.--------------------- \ ❑ Size: Diameter -----------------------------Depth-----------------------------------------------�"-'__Liq,icl Capacity-------------- -------gals. Privy: Distance From nearest well_------------------------------------------ ___Distance from nearest buiAin -- ❑ Distance to-nearest lot line----------------- --------------- -- -------------------------------------------------------------------------------------------------------- Remodeling and repairing {describes : ✓-, -..1�� ____- _--_--_�_--'}_ -------------- �y��- ----- --= - ., , ------------------------ ----------- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 Joaquin Local Health District. (Signed)- '� ��'t� -------- -------------------------------------------------------------------(Owner and/or Contractor By: i ------------------------------------------------ --------------------- -- -- - - - Title (Plot plan, showing size of lot, location+of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLYAPPLICAT , REVIEWEDON BY__ACCEPTED BY I = DATE. �----------------------------------------------- --- -- -- -- ----------------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------Al+erafions and/or recommendations:_} ____- -____....... .... > ___-- DATE-----"'-----_-__-: -- . •--- - --- - ------- `- _ t---- ------ ------�� - --------� 1=11_AEU:) 7`5 e_PR-8 -r)- FINAL INSPECTION Date--- -----------4� SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Norfh "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M Revisoo 1-57 F.P.CO.