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APPLICATION FOR SANITATION PERMIT Permit No. _____�l -J-- {Complete in Duplicate) Date Issued __// .�-S,�o Applica+ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance �with �County Ordinance No. S49. JOB ADDRESS AND LOCATION.-:),r„-----_ -.--- ��`p i Owner's Name ------------- Address ----- cel ------------------------ ---------- Phone---------------------------•- e----------------------------- Residence -----------•-- ----•------ ------ -----------•------••--------------- f _ef f!l_lrR�------_-_- Phone ry Installation will serve: Residence �-�f�� {Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_f-- Number of bedrooms .- - Number of baths ---/--- Lot size ---- i 2.ir - -- - --------------------•- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ElGravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No E �New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------- ❑ No. of compartments.- -- -----------------Size ------Material----------------------------------------- Disposal Field: Distance from nearest well -Liquid depth----------- --- --- ---.Capacity-- -------------------- anceromoundation_____________ ____Distance to nearest lot line----------------- ❑ Number ai lines ------- - -----------------Lengfh of each line------------------------------Width of trench---------------------------------- Type of filter material al___________--------------:Depth of filter material-__-____---___---------Total length- ---------------------------- -------- -- `* S 'Page P-t:, Distance to nearest well-----------------------Distance from foundation------.------------ Distance to nearest lot line__---_----•----_ GI�1 Number of pits----------------------Lining material__ -------------------- Size: Diameter___- -------- Depth--------- ” ---------------- Ce ool: — Distance from nearestel----- ----------Distance froom foundation_-------------------Lining material-_____. ,-----_---__---------_ �. Size: Diameter---------------------- -- - --- N ------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well__________________________------------_---------Distance from nearest building ❑ Distance to nearest lot _ ----------- --------- - - --- ---------- Remodel in and/or repairing fdescrihe): -__ e ...- �- I hereby certify that I have pre prepare tis application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules regul�Tns' o the 5 n a uin ealth District. q (Signed)-------------- - - t°'/'+/J-C�------- - - ---_(Owner and/or Contractor) By:--------- -- -------- ---- --- - ----- (Plot plan, showing size of lot, location of syst i re a+ion to wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------- BUILDING PERMIT ISSUED--- --_ DATE--------- REVIEWED BY--------------- ----------------- --•-- - ----- DATE------------------------ -- ------------ ---------- --- ------------------------------ ------------------------- •-- -------•---- DATE-------------------------- Alterations and/or recommendations_ = FINAL INSPECTION BY------ ----- -----__ _-.-_- _ - ___- -----3-- -- --' ---------------•- - " ---------- Date- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California , E5___9-2M 145446 AT.QOO 12-54