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APPLICATION FOR SANITATION PERMIT Permit No. ..._.��/ (Complete in Duplicate) Date Issued .._. ....- -------. P' s 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.. JOB ADDRESS AND LOCATION 1-13..1-. i ! -----5 _ F - ......... -----------------q------- --------- f lJv/V . Phone. �6 Owner's Name------------------- �..~.../�--`--------•-�-----•-7 -------•----------------- ---- ---------------------- I--- ----- -•-------^-- �-------- ----... * `-c.. --•-------------•-----------------•-----.....---------------------------------------•--•---•------- Address -------•--------------------------------- - Contractor's Name--------- •------------••--•-••----------•-----------------------•0 Y'"�----------------•----•--------------------------••---- Phone--------------------•-- ------ Installation will serve: ResidenNuApartment House F1 Commercial E] Trailer Court E] Motel ❑ Other ❑ Number of living units: -)--- mber of bedrooms Number of baths .-/... Lot size -_-.._....2. -+4 __________________. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam, Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑' No [Sr New Construction. Yes ❑ No 2�, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 294eet.) Septic Tank: Distance from nearest well---------Distance from -_ fgundati40........... Maite,rial--------------------_..__..-.. Jo. of compartments--- - 2 ----- ----Size---- _- 7.............Capacity...._ ----- Dis ' osal Field: Distance from nearest we! ..............._Distance from foundation_..- 6--.......Distance to nearest lot line........-.-_..... Number of lines----- ._.___Length of each line------------ ..----...Width of trench..........y��_-..-.... Type of filter mater ial_.__ .r..-.--.-.._ D,epth of filter material-------fp_�r...Total length....................rgd.-.__...-.. Seepage Pit: Distance to nearest well-.-----------_.------Distance from foundation----_--------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-.---------------------Size: Diameter.-.-------------------.Depth--------------------------------- Cesspool: Distance from nearest wO-----------------Distance from foundation--------------- _Lining material__-------------------------.._.V,.. ❑ Size: Diameter------------------------- -----------Depth--------- --------------------------------- --------Liquid Capacity- --•----- -------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------_------ -----. ❑ Distance to nearest lot line----------------- - ---------------------------------------•-•------------------------------------------------------------------------------ Remodeling and or re airin (describe):----- --------------------------- --------•- - -- x---------- 40-A Q- � - r ---------`� a : �---------- - .�. I hereby cert' a+ 1 ha ared +his application and that the work will be done in accordance with San Joaquin County ordinances, St law an u s a regulations of the-San-Joaquin Local Health District. (Signed]... ----- .-t----------- :------ ------ .--------------------------------------------------Owner and/or Contractor) By:-----------------------_------------- -------- --------------------------- -- ----=---------------------------------------------(Title)---------------------------------------------------------------- (Plot plan, showing size of lot, location o system in relkon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U-SE ONLY ; APPLICATION ACCEPTED BY------------------------------ ;------- ------------- ••-------- -------------- DATE------------ ---� --- -��------------ REVIEWEDBY---------------------------------------- ---------- -------------- ---------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- ------------- DATE.------------------------------ ----------------------------- { Alterations and/or recommendations------------------ --- _------------------------------------------------------------------------------ -------------------------- --------------------------------- --------------------------------------------•----- ----------------------•----- ._----.--... ...................................................................................... ............................................... .................. ------------ ------------ -------- � FINAL INSPECTION BY:.------lam- --------------------- ----------------- 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 145496 A-0D