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APPLICATION FOR SANITATION PERMIT Permit o. .91 (Complete in Duplicate) � Date Issued _ 11.5- - Applical-ion 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 LOCATION-_.-__ Owner's Name------_._ j,�Y�--•-- --------•---------------------------------••-------- Address---------- --•' ----------- Phone. ------- --------- --------------------- Contractor's Name--------------.�� "� '. � _ / ------ Phone Installation will serve: Residence M--'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -/--- Number of bedrooms __*Z_ Number of baths -__ --- Lot size - , -A--- -`-------------------- Water Supply: Public system ❑ Community system ❑ Private &O"Diepth to Water Table 3-1 ft` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan 0 Previous Application Made: Yes ❑ No t-INew Construction: Yes ❑ No 9�-' I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). ep is k: Distance from nearesi weft__,----- Distance from foundation--------------------Material_____.-____..._. _._-_.. -----•--------- ------ No. of compartments.-- ------Size--------------------------------Liquid depth----------------- --------Capacity--- - Disp Field: Distance from nearest well------------------Distance from foundation•___-.-._._---__._.Distance to nearest lot line___.._________... A Number of lines ------------------- Length of each line------- Type ._.Width of trench----•----------------- ------------- Type or filter ma#erial__.•-- :----Depth of filter material-----------------------Total length----------------------------------------- Seep it: Distance to nearest well-( �` i _._Distance from oun t�on___��_______-Distance�to nearest lot •ne_.- -_6 l�umber of its._..--/-___.._.._ p --Lining material-c- �ze� Diameter.-_� ---.-.-_-Depth-_.._. __ _` Cesspool: Distance from nearest well_______________ _Distance from foundation..-__._.-._.------- Lining material__.__.___----_.-___._._--_.. ti J ------ ❑ Size: Diameter Dept h Liquid Cap acity----------------------------gals. x _ Privy: Distance from nearest well _------------- ..................Distance from nearest building--------------------------------- Distance to nearest lot line___________________ , -------- -- - ------ Remodeling and/or repairing (describe)_________________ -- - --- -•---- 1 -•--------- ---------- --------- ----------------- --------------------------------------•- --------------•----------•----- ------------------------------------ ------------------------------------------------------------•----------•-•----•---------------•------•-----------------------------------------------•-------------------------------- I 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 Hea h District. (Signed) — If— By:. . Contract or)-------------•- (Title)--- '2 _ _____________ Pot plan, showing size of lot, cation of system in relation to wells, buildings, etc., can be placed on reverse si FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATE BY --------------- ----------------- -------------------------------- ' - . ---- . ------ DATE-_ BUILDING PERMIT ISSUED----------------------------------------------- -------------------------------------------------------- DATE--- Alterations and/or recommendations•11 --`---------- - ----` r - � -------•-- e ---�'-'`--=-----=----y. .'�I!`rt- -- ---�"a./ ..±r-�-�.�•?-�.•t,�e.rr•!�,�'.- t- ..! �----•--------.. - .. ------------------------- ------ -----t-- --•------•--r"_'-: _. i a;5 FINAL INSPECTION - ._ - •---------- -----_--------- ----••- -- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Sfreet 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es�9 145446 Arw000