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APPLICATION FOR SANITATION PERMIT Permit No. ____731.._. (Complete in Duplicate) Date Issued i Applica+ion is hereby made to:Mfhe San Joaquin Local Health District for a permit to construct and install the work herein described. Th is.application is made in compliance with County Ord' nce No. 549. i� -- JOB ADDRESS �AN,, LOC T' N----- --� - - -- - ------- --- -------------------------------------------------------------_--------- -- Owner's Name- ----- Phone-- ------------------------------ - -------------- - ----------------- - ----•- --- ---•------- -----------•-•---•----•---------- ------•---------------------------------------------------------------------- j Contractor's Name----- ---------------------- ----------------------------------------------------- ------------ Phone_T_=ZL_t-4------ Installation will serve: Residence P4--fClSartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: i!_1____ Number of bedrooms -3_ Number of baths _/-____ Lot size ;. r X__1_2_1r__________________ Water Supply: Public system'19L-Community system ❑ -Private ❑ Depth to Water Table SP ft. Character of soil fo a depth of 3 feet: Sand [D Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe ardpan E]i 9—We-E]Previous Application Made: Yes ❑ No Z�— Iew Construction: Yes L4-"I+' � TYPE OF INSTALLATION AND SPECIFICATIONS: p No septic tank or cess °ool permitted if public sewer is available within 200 feet.) - � . _.. Septic Tank: Distance from nearest wellhl-1- "t_-Distance from fo ndation=_-_ f `' No. of corn artments______. .... ____-____ Liquid de th__.�-. Capacity Q �- ,i p .�---�---------Size�.�. �----� � �.-- G p. �Jt.---------- p Y----- �*----�---- Disposal Field: Distance from nearest wello4�?o.-x,_,Distance from foundation___,t`O._'__...Distance to nearest lot line----yS--___..... --- Number oiilines----------1r._._.. Length of each line_-.__�_ _-- ---..Width of french---��-'___________________ ------------------------- ____1-of filter material -�---.-_---_Depth of filter materiaL_._��-.-___-.Total length_____�_C_________________________ 4-, i ,__� - See a e Pit: Distance t nearest well -,_____Distance om fou dation_____C_�__._-.D's.ante to nearest lot Ike_.__ t I p Lining material_�.Size: Diameter.--- I_-_�-----.Depth--J�------- .- its___.._ _ Cesspool: Distance rom nearest well--------------___Distance from foundation--------------------L'rriing material______-__________._.____.__. ____._. ElSize: Diam.titer----------------------------------------Dep!h----------------------------------------------------Liquid Capacity---------------------------gals. Al h " Privy: Distance from nearest well__________________�=__,__...____-.-____..___-_-..Distance from nearest building.____...____________________._.______._ ❑ Distance to nearest lot line---------------------------- -----------------------------------------------------------•---------------------- 4 Remodelingand/or repairing (describe):------------------------------------- -----------•------------------------------------------------------•------•-------•-------------------------------- ;I --------------•-•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ii - - - - . ---------------------------------------------------------•------------------------------------------------------------------------------------------•---• ---- ------- a ordinances,hereby-certify y lawand that have prepared this application.and that the work will be done in iccdMance with San Joaquin County Statees and regulations of the San Joaquin Local Health District. (Signed)--- ------y - - !;(Q 001 -.ao WA;-Q_ - i (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 --- ----------------------- - ----------------------------------------------- DATE------------- - ------- ----------- REVIEW IM------------------------------ - - f!-------- --------------------------------------- ----- DATE------------ ----� �.._-.- - ---•------- BUILDINGPERMIT ISSUED-----)i------------------------- ----V---------------------------------------------------------------- DATE--------------------- •---------------------------------- Alterationsand/or recommend tions-----------------------------------------------------------------------------------------------------------------------------••-------•------------------------- ----------------- ------------------------------ ------------------------------------••------------------------------ -------------------------------- ---- ---- ---'M--- -- -•-- } ----------------- -------•---- ----------- --------------- :p ----------------------------------- - --- - -------- - - -- - - - -- -------- FfNAL INSPECTION BY:.-.-_'' ------------------------------ Date------ a ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1, 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California I. r!3--9-2M 145446 ATWOOO 12-54 if �h c