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Permit No. _ � � --- ,�f APPLICATION FOR SANITATION PERMIT 3---•-----/-- (Complete in Duplicate) Date Issued ---- h Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install th work herein described. Y , This application is made in compliance with Count rdinance No. 549. Ns— o 10 _0P y4-v JOB ADDRESS AN CATI - - Phone----------------------------- ------ Owner's Name........ --•. ... . :... ........•--•----•-----= ---- -- ------•-------•---------------------- Address--- fa q_ ... -- -• --------------------------- --�--- 'rte-"---------•-------------------------------- Phone - 7 4" Contractor's Name----- _...__ __. ____ __ .- _ Installation will serve: Residence p�_Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms __Number of baths _/ Lot size . Water Supply: Public system ®/Community system ❑ Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0,Hardpan ❑ Previous Application Made: Yes ❑ No,2�__New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Si�zseta_.nce from Xfo-u-�n'd(a�tiLon--- Material------ - - � SeptTank: Distancecompartments nearest wVAiquid depth-------- Capacity__ ` ------- Noof compartments__-_... ----- ~_ Distance to nearest lot line.___��-. Disposal Field: Distance from nearest well__ istance from foundation___..___ Number of lines___._____f____ Length of each line------- Width of french------- --------------- Type of filter material__1 --------5 epth of filter ------Total length----------.$-.- . Seepage Pi}; Distance to nearest well_A16 rDistance from foupdation_____ L __--.Distance�to nearest lot line----�_---__ Number of pits------- -------- ----Lining material_ '- ' Diameter---... ---Depth----- ______.------ 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 of line--------------- ----------------•----- ---- - - ----------- Remodeling and/or repairing (describe)------------------------------------- --------•-----••---- - ----•------•------•-------------•--•---------------•-----------------------------------•---- `= ------------------•-------------------------•-----•-----------•--------------------------------------------- I hereby certify t at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State,{ W's and rules and regulations of the San Joaquin Local Health District. a,_ _ ----------------------(Owner and/or Contractor) Ifs------- ---------- (Signed) iwing = By:- --- ----- = ------(Title)------- ------- By: -----II---------------------------------- (plot plan, size of lot, location of system in Tela ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------ DATE------- ------------ {(� APPLICATION ACCEPTED BY - DATE REVIEWED BY--------------------------------- DATE------ ------ BUILDING PERMIT ISSUED---------------------------------------------------------------- ---------- - ------------ Alterations and/or recommendations:-------_- --------- --------- - --------- --------• -----------------:------------------------•------------------------------- 1 - ---- ----- - ----------. 1 Date...... J--------- 4�-----r----�-------------- FINAL INSPECTION- BY:..----------- -f - - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y 1S-9-'!M 145446 ATWDOD 12-54 -