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APPLICATION FOR SANITATION PERMIT Permit No. _._ .. ----- (Comp(Complete lete in Duplicate) Date `Issued Applica4ion 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 OC ITION- - .� t ... Owners Name--- --- - --------- ----- Phone---------------------- - ------------•-•--------------------- ---- ------- ------- - -- - - -- - Address--- -------- E � t. - --=- �Contractor's Name ------ s -----/ ---''`'o------- V 1- . -- ----- --- ------ Phone--------------- ------------------- Installation will serve: Residence Mr Apartment House ❑ Commercial ❑ Trailer Court E] Motel L] Other ❑ Number of living units: _ Number of bedrooms ___Number of baths ____I___ Lot size _ .r ± ______________________________ 1 Water Supply: Public systerr4Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ ti Previous Application Made: I�Yes ❑ Nazz, New Construction:., Yes N0 ❑ � TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dot n e'Ifrom nearest well .@ Distance from foundation_i_1X11_.-----------Material__ --------- ------------ ompartmenfs----_-- ------------Size_3_��" __ ------Liquid depth_ _________________Capacity- (__ Disposal Field: Distance:from nearest well_"'. __I1r�n <Distance from foundation____YI�___�_._..Distance to nearest lot line---2__,_ 1__-.__. Number of 'lines----------- Length of eat �_..Q-- ---------Width of trench..--: - -f__--------- T e of filter material_ _ e t i ter maten t h' ---------- Type Gr p Total lengthy •..' p i\umber 'to nearest we __ _ - -_ "• f ,S' ��___D' nce from foundation____ .__.____.Distance to nearest lot iine�__._ ------ Number _____ ti See a Pit: Numb r of 'its.------ g ii, e: Di eter__X'1_.--------Depth....... --_---- ' Linin m terial__�_�___�_ W Cesspool: Distance from nearest well_______________ is ante from foundation---- --------------Lining material__.___----__--____.._________________. ❑ Size: Dia meter----------------- ------- th--=------------------------ ------------ --------Liquid Capacity------------------------7----g lls: �» Privy: Distance from nearest well____________________________'-----------------Distance from nearest building------------------------------------------ ElDistance'pto nearest lot line_____ C. # < Re deling and/or repairing (describe): ___-- ------�5p�'? .�, -------••--•-------------- --------------- ----- -----------------------------------------••------------•------------------- ------------------------------------- - -------------------------------------------------------------- ----------------------------------------- ---•----- --- ------------------------------------------------------ I -•------- -----I hereby certify that I � ve prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules and-re ulations f the San Joaquin Lo-cal-Health District. (Signed)-•-------• •.---�--•A- - -�----- ------ -�-- ---- -- �� --------------------------------------------------------------------------------.(Owner and/or Contractor) By= 1. 3 !�� -------- ah -----------(Title)----�__ .J: .ta------------------•-------------_------------ if (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side): FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------_-__._-- -.___-- DATE__-__ - -- f ---•-------------------------- -------------- REVIEWED BY - _ DATE . ' EBUILDING PERMIT ISSUED--M------------ ------------------ - =--- DAT -s �. . , --------- � --- --- --- -- -`------Alterations and/or recommendation - - ,� ------------------------------ ------ -•----•-------- ---- �4-- ------- --- ---- -------- -------------------------------•--------- ----------------------- ----� ----------•-•----- ,, --------_-----------------------------•---------------------------------------• FINAL INSPECTION BY:.-9---- ------------------------ Date-----------.' o " S--- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 4 Stockton, California Lodi, California Manteca, California Tracy. California ES-9 145446 ATWOnD ��