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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica4ion is hereby made to the San-Joaquin Local Health District for a ri-nif foconstrqct and install the work herein described. This application is made in compliance with County Ordinance No. 549.- _? r;(_ I,- JOB ADDRESS AND TION__ ------;7z"7--L ------- _.I-ed-------------- �_ Owner's ------------- ------------ - ------------ ------------------------------------------ Phone------------------------------------ AddressY ----------jr," --------------------------------------------------------------------------------------------- Contractor's Installation will serve: I Residence R_ Apartment House E] Commercial [] Trailer Court E] Motel [-I Other F Number of living units: Number of bedrooms :_Number of baths .__/--- Lot size ------- -----_-------------- Water Supply:' Public'system � Community system El Private E] Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy'Loarn El Clay Loam El Clay El Adobe 13,_Hardpan El Previous Application Made: Yes E] Noja— New Construction: Yes,124—No El TYPE,OF INSTALLATION AND SPECIFICATIONS: .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) i -Y 'A e Septi6 Tank: Distance from nearest well/_Vvv_,�Distance from foundation---/0---------Material---- -------e----- No. of compartments-' _----------Size-- --- _--Liquid clep.th----j�_ 2_4------------Capacity------ nearest well_W Disposal Field: Distance from 47_7.1asfance from foundation----za�......Distance to nearest lot Number of ..............Length of each line-__.__-5�6_1 Width of french-----gp I 91 r - w- ---I-------------- L Type 01 filter Depth of filter material-----/__.F`j--Total length--------1�3_ ------------------ Seepage Pit: Distance to nearest �veli.. /IZ/d?Zg_ Distance from foundation______ Distance to nearest lot line..__. IRr- Number of pits------/-------------Lining; maferial__�14?-�.- -------------- C pool: r ! ess ' Distance f-rom nearest well-----------------Distance from foundation.. ..............Lining material_____-_-____-_______.__________-____. F1 .. Size. Diameter------ -----------------------------:_Depth--------------------------------- ------Liquid Capacity----------------------- ----gals. Privy- 'Distance from nearest well-------------I-----------------------------------Distance from nearest building____.______.__________..___-----._-._ F-1 Distance to nearest lot line------------------------------------- --------------------------------- ----------------------------------------- --------------------------- Remodeling.and/or repairing (describe):------- ------------------------- ----------------------------------------------------------------------------------------------------------------------- --------------------------------------m--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------•---------•-------------------------------------------------- -- i ------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby cerfiff JhAffl�have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, a rules and regulations of the Sari Joaquin Local Health District. (Signed). - ---- -- --- -- ---------6------------ -------—--- ------- - ---------------------------------------- ---------------(Own ggand/or Contractor) location BY. _ :� - , wells, buildings, ----------------(Title)----... '•--------------------------------- (Plot plan, s owing size of lot, location of system in relation 'Idings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION-ACCEPTED BY.-.-- ------- -------------------------------------------------------------- DATE------ W------------------------------------------------- REVIEWED BY-------------------------------------- --------- ----- DATE / L -------- ------------------------------------------------------------ ---- - ------------- BUILDING PERMIT ISSUED------------------- - - 25 ------------------ ------------------------------ DATE_ - ------ --------- � Alterations and/or recommendation! --------------- --- -------------------------------------------------•-------------------- - -\111 �---------- ---------------------------- ------------- ----- ----- --- ------ ------�_4---- -------------------------------------------------------------------- ----------- ---------------- .-_t; 0 --------------------- ------- ---- ------------------------------------------- -------- ---------------------------------------------------------------------------- -------------------- --------- - ----------------------------------------- ------- ------------- -----------------------------------------------I-------------------------------------------------------------- ----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- D -------------------- ----- - FINAL INSPECTION BY:-- --- -----<�� ...............S------------------_----- Date --- --- -- ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfree+ $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M S4.G ATw... l2_54