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APPLICATION FOR SANITATION PERMIT Permit No. _. ...__ ... (Complete in Duplicate) Date Issued ._-?/�'-4c be Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrid. This application is made in compliance with County Ordinance No. 549. a �-- --- -----••-------•----- ---- JOB ADDRESS AND LOCAjION______ J-`�=`-'E--�--------- ----- - Owner's Name____ ----- Phone------------------------------------ Address--------- ___ ' P- `-- ------ -•i-�-------- ------------ ----------------------- Contractor's Name---- _Y __._ y Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ,l__._ Number of bedrooms __Number of baths �___ Lot size .......0-C?--2' z ---•------•-------- Water Supply: Public system JZ Community system ❑ Private ❑ Depth to Water Table Off. ft. Is Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No U�-_ New Construction: Yes g, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: . Distance from nearest well-________________Distance from foundation--------------------Material ____-___._..____..__.._____-----______..____--- ❑ fx_e_ .c-c_o. of compartments------------ -------------Size-----•------------------•--- Liquid depth--------------------------Capacity----------------------- Disposal Field: "Jstance from nearest well-___...___-__._Distance from foundation------------------- Distance to nearest lot line----------------- ❑ y®�� ber of lines-----------------------------------Length of each line-------------------- Width of trench ype of filter material____________ Depth of filter material----.-.___.____-----._Total length------------------------------------------ ------ Seepage Pit: Distance to nearest well. /L i Distance from foundation___: - Distance to nearest lot line..--'P-,d--.r-- Number of pits----- ---------------Lining material ....... " e: Diameter--'�-Je."e----Depth......c - --------------- Cesspp000l: 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 -------- --=: ----------•------- -------------------- Remodelir�g 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, S+ate Iand rules and regulations of the.san Joaquin Local Health District. (Signe ` "'' ------ ------(Owner 'end/or Contractor) ---- 8 ' -(Title)------- ----- ----------------- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings. etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ``�— -----:.:`-_ --------------------- DATE---------------------------------------------------------------------------------------------- ��_- DATE- REVIEWEDBY- ---------------------------- ---- ---------_ - --- -- ----=- -• ------------------------------ ---- 7 BUILDING PERMIT ISSUED---------------------- --=== DATE------.-------- --- 4- --------------------------- Alterations and/or recommendations:________- ��+, - -----••-------`-- -•-- ------- -----•-------•--------------•-------•---•------------------•-----------•----------------- i [r . .. .Jy ----------------------------------------------------- ----------------- --------------- -- - ------------- -----------•-------------•-------•-------- FINAL INSPECTION BY:...... _ .................... Date---- _ 7-----��. --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street in Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California FS-9-2M 145446 AYW0aD 12-54 - Y