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31� APPLICATION FOR SANITATION PERMIT Permit No. ...8 6_.....----. (Complete in Duplicate) 3 Date Issued .._--/-/zl_ Application 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. JOBADDRESS AN LO TIO � --- - ---- f - ---------------------------------------------------- .- --------------- ---•--------- ^ -------------------------------------- Phone�--1 --�I � Owner's Name-_ - - --. --------- - ---- • Address__,3a-t------ -- ------------- --•----------------------------------- -------.--------•- Contractor's Name--------_-------------------- -- ----------------------------------------------- Phone. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Number of bedrooms .a- Number of baths --�Lot size ---- �-_`_ - -- --------------- Water Supply: Public system 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 0__f�ardpan ❑ Previous Application Made: Yes ❑ No lew Construction: Yes ❑ No D' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I pti k� Distance from nearest well ________Distance from foundation---_______-____.._.Material----------_________.___.____________-____--___-_. No. of compartments--------------------------Size------------------------•-------Liquid depth-------------------------:Capacity----- Disposal F' d: Distance from nearest well-------------- from foundation___.__-___._.._.__.Distance to nearest lot line _ Number of lines-------- ------------------ ----Length of each line-----------------------------Width of trench Type of filter material-_______________________Depth of filter material.- ----------------Total length----------------------....... _______._____ � __.Distant om f undafiion___ /� Distance to nearest lot line_________________ Seepage Pit- Distance to nearest well _ __ /• ---'.--- n Number of pits.____-__------__Lining material_p -Size: Diameter._..____-_--_Depth_-. ._____--_------_--- Cesspool: Distance from nearest well________________ Distance from foundation ----------------;_ Lining material--------------------------------------- \j ❑ Size: Diameter--------------------- - --------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------- --- Distance from nearesf building____________________________--.--__.___. ❑ Distance to nearest lot li ---------- - - / -------------- Remodeling and/or repairing (describe}: A4.1- •- -------- 'may �� - -------------------------------------- -----------------------------------I------------------------•---------------------•-----------------------•---------- ---------------------•------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with an Joaquin County ordinances, laws, and rules and regulations of the San Joaquin Local Health District. ( and/or Contractor) (Signed)..- ... her By: -----------•-----------{Title) ------ --••----- (Plot plan, showing size of lot, location of system in relati to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION'ACCEPTED BY--------- ------ ----------------------------- ----- DATE 0------1 REVIEWED BY'------------------------ ---- -------- -- ------ --�--------------------------------------------- ------ DATE--------rV_------------------------------------- BUILDING PERMIT ISSUED. _ DATE------- Alterations and/or recommendations----------------- - -------- ------ - --------------------------•----------•---------•-----•------• ------------• -------- ---- ;� --- `'"'"' 1 y tR_r$ - -- ger ' '. ------------- - -- - � ? = • FINAL INSPECTION BY-.--.� ------------------------ --- Date-- =----I--F-r- -- ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California rF--.s 14Sa46 ATWODD