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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and in SII t e tereiq descj04, This application is made in complia c .wit Cou +y Ordinance No. 549. c�E _ r t JOB ADDRESS AN CAT ON.... - ------------- --= ---------- -`" --- --- Owner's Name- ..----- ------------------ -------- -------------------------- Phone--------__-------•-------------- Owner's Name- - --- -------------- ------------------------------------------ ------------------------------------------- Address Name.... ..... . .. .. 'tiJ-----�--------- t r - ------------ Phone ,7 Installation will serve: Residence [21—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 6 . Number of living units: _1.._-- Number of bedrooms __y. Number of baths _l___ Lot size - ----5_______________________________ "' Wafer Supply: Public system 'Community system ❑ Private ❑ Depth to Water Table �,4ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IA. Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes-9g_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) a r_ Septic Tank: Distance from nearest well_X_e? Xistance rom foundation---jQ__F_.___.MateriaL�s -___...____.. r (� No. of compartmems--- ----- ----------Size Si,,, _ Liquid depth..--- �-----------._Capacity.._- --------------_ Disposal Field: Distance from nearest efl__��J'Lf..Distanca from foundation_____ .......Distance to nearest lot line_ ��__- ,} Z[� Number oT lines----___--- -- _r_ ._l-1..��... .Length of each line----------�� t.r_.._.Width of trench-----o�__r •-------------•_-- Type of filter material- -Depth of filter material Total length______--fid________________________ ' ( -- .gyp _- �.._.___-Distance,to nearest lot line________ Seepage Pit: Distance to nearest well_._.�� -0is+ante from foundation___ .{ IXL Number of pits_____.............Lining material4;__C� Size: Diameter___. .____Depth-----cVfd_1___________--__ { Cesspool: Distance from nearest well-----------------Distance from foundation.---------------- - Lining material__.--------._.--._-.________-________. ❑ Size: Diameter-------- ---------------- -----.--.-.Depth-------------------------- -----------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--- -------------------------------------- from nearest building_.__._____.__.___________________.____.._. ❑ Distance to nearest lot line------------------------- --------------------------------------------------------------------------------------------------- --- d- ..----•-------------•------------------------------------------------------- D Remodeling and/or repairing �describe�:______ _ ___. __________________ ---------••---------------------------•-------------•-------------------.....---------------------------------- -----------. ---------------------------•----------------------•-•----------------------------------------- -------------------------------------------------=--------------------------------------------------------------------------------------7--------------------------------------------......---------------•--..----------- ------------------------- ---- -----------------•------------------------------•--------------------------------------------------------------------------- --------------------------------------------------------- I hereby cerfif .that 1-have prepared this application and that the work will be done in accordance with San Joaquin County C ! ordinances, Sta la and rules and regulations of the San Joaquin Local Health District, f71 r �- - :__..____(O er and/or Contractor) (Signed)...--Fowing --------------------------- -- ---- - ----- ----------------------------------- r Ry: L �.� (Title) (Plot plan, ize of lot, location of system in relation to wells, buil(lings, etc., can be placed on reverse side). F ;�R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ----------------------------------------------- DATE------- �:--------- ------- •------------ REVIEWED BY---------------------------------------- - - ------\o'_ —.i------ -------------------------------------- DATE----------- ----- ._ BUILDINGPERMIT ISSUED------------------------------- ----------------------------------------------------- DATE----------------- --- `� ----------------------------- Alterations and/or recommendations--- ----------- - -- - -- ---------------•---------------------------------•-------------------- ---------------------------- �-- ------------ ----- ----------- - --------------------------- -- ---------------------- f / ---- -------- 1 ------------------------------------ -------- ------------------------------------ --------- --------.-�----------------------------------`......---- � ti--------------------------- ------------------------------------------------------- V FINAL INSPECTION BY::--- il/_- Date -----�---�� --------------------------------- 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 / ES-9-2M 145446 ATWUUD 12-54 r r• lL }