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APPLICATION FOR SANITATION PERMIT Permit No. ..�.-1---J----- � (Complete in Duplicate] �Date Issued .---/ Applica{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 compliancewithCounty Ordinan e No. 549. , JOB ADDRESS AND L CATION...>F r Owner's Name - --- ----------- - Phone e. Address----&...• - - -- t� ---------- ---------- ----------------------------------------- Address •--------------------------------------- Contractor's Name..... •---------- ------------------------------------------------------------------------- ------ Phone=- I Installation will serve: Residence partmen+ House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number.of living units: --/-- Number of bedrooms _-l- Number of baths _,---- Lot size ---JV_ --__A---�_ -----------------_--__-- Water Supply: Publics stem ommunit system `� I PP Y� y ��' y y ❑ Private ❑ Depth +o Water Table�-.-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No [a�ew Construction: Yes ❑ No E5- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) So f' T� Distance from nearest well-----------------Distance from foundation--------------------Material----------_-------------.----------------------- ; No. of compartments---------- Size--------------------------------Liquid depth--------------- ----CapacityI isposal Field: Distance from nearest well-----------------Distarice 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_-----.-.-_--------------- _-----_.-- Seepage Pity Distance to nearestwell_ ---Distance from fa ndation__A -`----_.Distance: to nearest lot line--- c L� Number of pits..-.---�_-------..Lining material-_40tr..R! ...Size: Diameter-23-1------------ Cess ol: .'..------Cesspool: _ --Distancelfrom-nearest•-well_= .......:_:Distance from foundation--------------------- Lining mater ❑ Size: Diameter--------------------------------------Depth------- --------------------- ------Liquid Capacity- gals. \* Privy: Distance from nearest well------------------- --------------------------__-Distance from nearest building------------------------ _-:.--.---.--.. V ❑ Distance to nearest lot line---------------------- ---------------------------------------- Remodeling and/or repairing (describe)=------- -------------------------------------------------•-•-------------------------•--------- ------------------------------- -----------------------.1-1----------------------------------------------------- -------•---------------------.-....-----•--------•-•------•----------------•--••------------------------------------------•----------------------•--•---------------•-------------•---•-------------------------------------••------ ------ ------------------------------------------------------------------------------------------•---------------------------••-----•----------•--------------------------------------•----•-----------•----------------------- I hereby certify that I have prepared this application and +hat 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. (Signed) !i- ------------ - ------------- -------------------- - ----------------------- - -- ------- ---- ---------------- ---- (�� Contractor] B ------ Y Z - --- -- ------- ------------------------ ----------------------------------------(Title]-------------------- ---------------------------------------- -- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ DATE --- REVIEWEDBY---------------------------------------- ------------- --------------------- --.-._ DATE---•--- -a '� BUILDING PERMIT ISSUED-------------- ----- -------- -- ------ DATE-.-------------------- ��- Alterations and/or rec mendations: - ----- ---------� ..---------- r ------ - ---------------- 1 �" (---------------------------•-----------------•----•-----------•--------------- s' -----------------------------------------•-•-------------- ----••-------•------------- ------------------------- ------------- ---------•-•-•--------------------- i —------------------- -- ---- ------------------ - ------------ --------------------------------------------------------------------------------------•----•-----------•-...-------- ----------- - ---- ---- -----•-------------- -------- ----------------•------------------- - ------ FINAL INSPECTION BY%.----------- - ---------- - -- --------------- Date----------^---d 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 ATWOCU 12-54