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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) "� S Date Issued s_ /___, ApplicaFion 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 jjCounty OrOrdinance No, S49, JOB ADDRESS AND LOCATION__-- _3 _ �'�-..��. - ' Owner's Name----- � !' . Phone -------------- --------------------- Address . - �- -------------------------------- r Contractor's Name--•---..... ..xe L,A----_-- ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --f._._ Number of bedrooms . __ Number of baths ---/.-- Lot size -,$—e_rx----_-`j --------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 41071 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8--TAardpan ❑ Previous Application Made: Yes ❑ No 8---'New Construction: Yes ❑ Noa[ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tank: Distance from nearest well__,______________Distance from foundation--------------------Material____________.__.__.____.__________..___..______.. No. of compartments------------- ------y-`Size--------------- ----------------Liquid depth--------------------------Capacity----------------------- E Disposa�Field: Distance from neare t weki_i�':�..._Distance from foundation__._____._.-.-.Distance to nearest lot line... .......... Number of lines------------------------>7__ 'Length of each line____��`__.------------ f .Width of french _________________ Type of filter material-/ _ ��Depth of filter materiaL_.. ._-.Total length------c','_4` ------------------- Seepage _____ _ __-------See a e"Pit: �iu�aneeQf nearestwell-, �- Dcm fou ation_____ _________ Distance to nearest lot line__F.___-___- ___. Number p' Lining mterial4 G_. :Size: Diameter.— --------Depth_...4_J ----------------- CesspoolDistance from nearest wed_________________Distance nd&f on__--- ---------------Lining material___._________.______.________________ ❑ Size: Diameter--------------------------------------Depth------------------------------------.-----------!!--Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------_----___------------__Distance from nearest building------------------------------------------ El Distance to nearest lot line----- -----------J-----f--,-- ----- ---------f-------------- Z ----------------------------- Remodelingand/or repairing _____________ t___---- __-___- -_-_ -------------------•--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- 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) -- ------ -----`.,�' �``-=1•�`-------------------------------------Owner and/or Contractor -------------- By:----------------------------- - - -- -P•E''---- lz- (Title)' " (Plot plan, showing size of lot, to an of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- ----- ---------------------------------------------------------- DATE-----1 ----------------------------------------------- REVIEWEDBY-------•------------------------- ---- ---- -1-- ---- -------------------- --------------------•-------------- DATE----- BUILDING PERMIT ISSUED------------- DATE--- ------ ------- -•••-----•---- Alterations and/or recommendations:___.__.________ ____ __ ____ -------s ------- --------------------- -------------------------- — — �' - -- -------------------- J --- -----•------ -- A -- ------ ---------------------------------------------------- --- --------I------- ----------------------------- --------------------- -------------I--------------------------------------------------------------------------- .. S1 8 �FINAL INSPECTION BY------------------ ------• ----------------------------------. Date.------------------------------ ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Was+ Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California S-4 145446 ATW000