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APPLICATION FOR SANITATION PERMIT Permit No. .... ............1._ (Complete in Duplicate) J Date Issued ._- S 7 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 Ordinance No. 549. JOS ADDRESS AND LOCATION...---a `�-- ---------- ---------------------------------------------- -- --- ------------------------------------ --------•---------------------------------------------------------•---------------------- Owner's Name_ ------------�------- '6.�7 t.� 8 `3' � ---•• - -------------- ----- - - - -------.. Phone-- -- ----•----.� L Address - -------- ---------- -------------------------------------------------------------•--•------------�----'---f--------------..--.......... Contractor's Name .- ----- ------------------ ----------------------------------------- Phone-! -4`1 O 7- Installation will serve: Residence [E—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -- Number of baths .-Z-- Lot size ----40!x.--�3- ................-------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table CO- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B-`Hardpan ❑ Previous Application Made: Yes ❑ No ❑C— New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic Tank. Distance from nearest well --------------Distance from foundation--------------------Material-----------------------------.------.------------ No. of compartments--- -------------------Size--------------------------------Liquid depth----- -------------------Ca acit sp J, field: Distance from nearest well-----------------Distance from foundation_--.------------_-.Distance to nearest lot line----------------- Number of lines-----------------------------------Length of each line------ ----.-.Width of trench ---------------------------------- Type of filter material----------------------_-Depth of filter material----------------------Total length------------------------------------------ Seepage .� Seepage Pit: Distance to nearest well. --_ --_-Distance rorty f ndation--3Q---_-----.Distance to nearest lot line.3D- ---- Number of pits.----/-------------Lining material--___Size- Diameter.---,?.3.,�-...--_Depth-- e_.s7-.-------.-._------- Cesspool- Distance from nearest well--------_-------Distance from foundation--------------------Lining material---.--_--..---.----.---.--------_--. ❑ Size: Diameter-------- --------- -------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------____------_-------------------------------Distance from nearest building ------------- ❑ Distance to nearest lot line --------------------------- ------------------------------------------------------------ '=-- ----- Remodelingand/or repairing (describe):-•------- ---------------------------- -----------------•-----------------•----------------•-- -----------...-------------------•------------------- ----------------------------------------------------------------------•----•------------ -----------------•---------------------------------------•-------------------------------•------------------------------------------ ----------------------- -----------------------------•-----------•--------.-.-...----•---•----•--------------•--•--------------------------••--••--------------------------------------------------------•------------------- 1 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. (Si ned ---mo i 9 ) ------------------------------ - -- (Owner and/or Contractor) ? � - �c, �L By:-------...........•---------------I?.�+ c2. 1. - ----------------------------------------(Title)--- (�------------------------------------------ (Piot plan, showing size of lot, location of system in Alation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------ -------- ---------------------------------------- DATE------ .� REVIEWEDBY------------------------------------------------------- ---------------------------------------- DATE---- ----------- BUILDING PERMIT ISSUED----------- ----------------------------------------- -- DATE - ---------- �.. Alterations and/or recommendations:---.- . .----- --. - :- - --------------------------------•-------------------------------------------- ----•- -------------------•--- ------------------- f ------------ .------•------------- ----------------- ---- -----•--••--••-------------- ------ ------ " =- Y t ---� :�..�„ -----• -------------------------------- -------------------------------- -------------- ------------------------------------------------------------- -- ------------------------V-------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:----- ----------------------------- Date......J........1-77----=- _-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 F E3�9 145446 ATW-D