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r' APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .......G.l- __ Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. A� JOB ADDRESS AND LOCATION--------/D. o�. ��- � - • -• N Owner's Name------_----------- Phone _ �Q Address --- --------------------------- ----- ------------------------ 74 Contractor's Name--------------------------------- ------- -- -'•-----• ------ Phone..� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �s�� /ate 1____ Number of bedrooms _ _ Number of baths _�___ Lot size:__________________________.________..__..______.___._.____ Water Supply: Public system 9KC--ommunity system ❑ Private ❑ Depth to Water Table. ft. Character of soil to a depth of 3 feet_:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [L�--Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epti Tank: Distance from nearest-well-----------------Distance from foundation____________-_-___.Material-__-_--__-__-__-___-_____---________--___-______- No. of compartments--------------------------Size------•-------------------------Liquid depth---------------- ---------Capacity----------------------- Disposal , ield: Distance from nearest well-----------------Distance from foundation-------------------__Distance to nearest lot line----------------- ElNumber of lines---•-------------------------------Length of each line-------------------- ,-------Width of trench--------------------------------__- ` Type of filter material------------------------- of filter material------------------------Total length--------------------------------------__-_ Seepage it: Distance to nearest well-_�__Distance from foundation__34__-.......DDiisttan e to nearest lot line_ ______ Number of pits------ ------------Lining material��_,_ . ! C'Size: D.iamete r________ ___--__---___Depth---d ___________________ Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material__-_---.--____-_____-______-_________. ❑ Size: Diameter--------- ----------------------------Depth- --------------------------------------------------Liquid Capacity----------------------------gals. \ Privy: Distance from nearest yell------------------------------_ -------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- - •--------------------------------- -•-------------------•------------------------------------------------------------------------ Remodelingand/or repairing (describe):------ ------------------------------------•--------.-•----------------•----------•-----------•--------•- •-------•----•-1•----------•----------------- -------------------------------- -----•---------------------------•--------------------•-•--____--------------•--------------------------------------------------------------------.------------------------------------•----- ---------------------------------------•-------------------------------------------....--------•--•---•------------------•----------------------•-------•-------------------------------------------------------------------- ----------------------------------- --- ------•-----------••----------------------------------•-•--------------------------------•-•------------------------------------------------- ------- --••-- - I hereb��rrP y that I have prepared Phis,application and that the work will be done in accordance with San Joaquin County ordinances,iSws, and rules and regulations of the San Joaquin Local Health District. � (Omer and/or Contr efor) (Signed)--------- ---------- -- - -------------------- --/- B ----•! t_ .. ,/ fes -------------------------------Title_ (Plot .plan, showing size of lot, location of system in re tion to we11s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATIONACCEPTED BY------------------------------ ---------- --------------------------------------- DATE-- -�/-----•-------- --------------------------------- -- -------------------------------- REVIEWED BY---------------- ��'� •` ------------------------------------- DATE s ----- BUILDING PERMIT ISSUED--------------------------------- -- ---- J = - f ----- ------ DATE-__ -Alterations and/or recommendations:_--------------- - - •-••- --- - ___________-------------_----------------------- ___ ___ ------ ----------- ------------ ---_ ---- --- . - --- ----•---------------------= ---------------------------- __ _ __ - __ .____-.___ __._-- ---------------------------------------------- ---- _ _ --- --------------------------------- ----- ______________________ _ _________________________ _________________ ______ ----------------_-------___..............._------------- . FINAL INSPECTION BY:______ --- `--_ °--- - ' ' f cc Date v--------••------•- ••-•------------------ 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California r9-9-•-2M 145446 ATWAOO 12-54