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APPLICATION FOR SANITATION PERMIT Permit No. ____- (Complete in Duplicate) 3�y Date Issued ______ Applica}ion is hereby made to the San Joaquin Local Health DHstrict 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 O ATION �_-. u ------- -- --- --------------------- ------------------•------- Owner's Name...._____. _ ---- --- ' ------------------------ -----------------_-- -- Phone-------f�.r=-------------------- Address----•---------------------------- `�--------------------------------------------------------- ---------------------------- -------------------------------------------------------------- `-� Contractor's Name-------------- 7.. �F .�-`t�_ � '�- - -------------------•------------------ Phon '_.. . ' _ Installation will serve: Residence," Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ -___ Number of bedrooms _5 Number of baths _�-_- Lot size --- -------------------------------- --------- -------- Water Supply: Public system grolEommunity 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 9--`1New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well_, --Distance from foundation__.�__2---..._-Material____ _________________________________________- �o� .r rx_ _Liquid depth_._'_4_°..........Capacity--� No. of _-_-_..._._._----Size__...-�_-- osal Feld: Distance from nearest well ._....-____._Distant$ fro dation_______________._.Distance to nearest lot line_______-________ , j Dumber of lines-----------------------------------Length of each line-------- ------.Width of trench.---------------------------------- Type of filter material-________________________Depth of,rfilter material------------------------ ota€ length---.___.____________-____________-....____ ' Seepage Pit: Distance to nearest well-------------_--------Distance from foundation_-.----------------.Distance to nearest lot line------_________. ❑ Number of pits- --------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material____...__.____.._.___--.-----______. Size: Diameter = -Depth------------------------------------------- -------Liquid Capacity-------,---------------------gals. Privy: Distance trom nearest well-----------------_---------------.---------------Distance from nearest building______.._---_---____.________________----. �k ❑ Distance to nearest lot line--------_----------- ----- ------- delis and re iris describe):_.- -- -- - --- - `-------------- Remg g ( -- '� ` � .� - -__-- '�`-----t'-r = - -. ------------------------ -------------------------- --- - ------ ---�--- --------------- -------------------------------------- - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. DAY& NIGHT r Contractor) (Signed) �° 9 --------Go -----•-------'SepTic-�TantC--Servrce B --- Ob_SQ,_Eldar+�dQ kfQ_2.7rG-------- ---- -- ----------- -----------(Title) -------------------------------------- (Plot plan, showing size of lot, IJARFi�M F#An in relation to e1 s, buildings, tc., can be placed on.reverse side). a FOR DEPAR MENT USE ONLY ------ DATE APPLICATION ACCEPTED BY----- ------------------------------- --------- -----------•--------------------------------------- REVIEWEDBY-------------------------------- ------- DATE---_.3V----------------------••----•--------------------•- BUILDING PERMIT ISSUED-------------- -- ----------------------- -----------------•--------------------------------------- DATE.----- —------------------------------------------------ Alterations and/or recommendations:------------------ .......... 01.k V Q a�... ------------ ----------------•---------------------------------- ---•------- --------------------------------- FINAL INSPECTION BY--------- --------- ------ ---- Date.... --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 132 Sycamore Sfravt 814 North "C" Street SManteca, California Tracy, California Stockton, California Lodi, California EE-9-^2M 145446 A7WQ9D 12-54