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APPLICATION FOR SANITATION PERMIT --- (Complete in Duplicate) Permit No. ----- Date Issued.-_ Aplical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application ,, application is made in compliance,,wifh C ty.Ordinanc6 No. .549.' JOB ADDRESS AND LOCATION..:__ ---------- Owner's Name-----------......W --------------- ------------ ......... Phone67 Address...--------------------------M4117....44?-------- 19/V ----------------------- 7 V ------------------------- ------------------------------------------- Confr'acfor's Name----, ---------------------- ----- --- ---- ----- Phonele- :-�A4<7 Installation will serve: Residence Apartment House E] Commercial [] Trailer Court [j ' Motel E] Other E] t Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size _/e90 Water Supply; Public system El _C6M'_m' Gnity system El Private JK Depth to Water Table-5-L$_ ft, Character of soil to a depth of 3 feet:F Sand Ej Gravel E] Sandy Loam E]" 'Clay Loam E] Clay E] Adobe Hardpan E] Previous'Applicatidn Made: Yes E] No E] New Construction: -Yes E]- No 'W" JK TYPE,-OF INSTALLATION AND SPECIFICATIONS: AL (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: _ Distance from nearest well-------- -------Distance from foundation....................Material-------__------__.__-- --- --------------------------- 0 al,,TZA(G-No, of.compartments-- -----------------------Size-------------------------------.- Liquid depth_.:----------- -----------Capacity..--------------------- Disposal ----------Capacity--------------------_Disposal Field: Distance from nearest well----._.__.__..._Distance from foundation------------------- Distance to nearest lot line----------------- El�X6,17AC-" Number of lines-----------------------------------Length of each line..................... Width of french Type of filter material-------------------------Depth of filter rnaferial---------;-------------Total length----------------------------------------- L , I 1 01 Seepage Pit: Distance to nearest well—IX40-------.-Distance from Tfqunclation_/2�........Distance to nearest lot . I Si Number of pits--1 -----Lining materia_10seK ize: Diameter-_--_. Cesspool: Distance from nearest well-----------------Distance from foundaf ion ---- --------.-_Lining material_-_-_-__.-____--..._.------_ ❑ aterial--- --------------- ----------EJ Size. Diamefer._J_------------- ---------Depth--------------------•------- ---.-Liquid Capacity----------------------------gals. -I - Privy: Distance from nearest well------------------_---- -----------------1 __.---.-Distance from nearest building---_--_-_---__-------_-_ --------- f ------------------- El Distance to n earest lot line.-----_- ------------------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--- ----- ------------- ----------- -- ------- -------------------------------------------------- -------------------------------------------------------------------------------------------------- ------------ --------J_�-- - ----- --- ---- ---------7------------------------------------ ---------- - ----- --------------------------------- -------------------------------------- -------- --------------- ---- --- ---------t----------------------------------------------------7t-------------------------------------------------------------------------------------------I--------------------------------------------------------------------I I hereby certify that I havep`re_ red this applicafion and that the work wilFbe done in accordance with San Joaquin County ordinances. State laws, and es an regulations he San Joaquin Local Health District. (Signed)------------------- ------ ......... -------- ------ -- ---- -- --------- -- - --- -------- ------------- --------------- ----------------------(Owner and/,Or Contractor) By---------------_-------- --- --- ------- .. .......... . --- -------- - -- - ----------(Title) - ------------ (Plot plan, showing size o lot, location of system in relation wells, buildings, etc., can be-placen reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y- -------------- ------ -----------I-------------------------------- DATE-- ... REVIEWEDBY------------------------------------------------------- -__ --------------- -------------------------- DATE- -- ----- ------- ------------\-> ----------------------- BUILDING PERMIT ISSUED - *------------------------ DATE- ------------- -i�. ----- ---------------------- Alterations and/or recommendations--------------------- -------------------------- -----------*---------- ----------------------- --- ------- ------------- -- - 0---------------- --------- --- C-------------------------------------------- -- 1 ----- ---- (-�_�u-4- ------------------------------------- -0 r --- -------------- A" ---------- -------------------------------------------------- ---------------------- - ---------------------------------------------------------------------------------------------------------------------------------- ------------------- ------------------------ ----------------------------- - -------------------I--------- --- ---------------------------------- ----------------------------------------------------------------------------- - FINAL INSPECTION BY: ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWOnD