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APPLICATION FOR SANITATION PERMIT Permit No. ...le.._7:.-Z. (Complete in Duplicate) �/ S5� - Date Issued ....../�...------ ' Applica4ion 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 A CATION--..;✓.----- --- ..-.E . O .. --------•-__..............................-------t.............. Owner's Nem l ................................ Phone.............................-- - Address-- - - ..........- ..... W..... ... -- -- -- ...._...... - ,. -�� Contractor's Name.. - ..............-....-•-- ... Phone - Installa+ion will serve:l Residence 4 hp ent House ❑ Commercial ❑ Trailer Court ❑ -' Motel ❑ Other ❑ Number of living units: �..... Number of bedrooms ._Number of baths ./.. Lot size ...S A_...... ...I._.2.T-_� ... Water Supply: Public system A-community system ❑ Private ❑ Depth to Water TabZi;?. ft. Character of Will to a depth of 3 feet Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 4&-New Construction: Yes ❑ No1_4+� ,a TYPE OF INSTALLATION AND SPECIFICATIONS: (No ieptic tank or cesspool permifted if public sewer-is available within 200 feet.)t I — - . *+ - _ - - - Septi Tank: Distance from nearest well._,.-------------Distance from,foundation.........._.......Material._.............................................. No. of compartments................ ..........Size..................-..'..-.—:Liquid depth_._-............_.._Capacity..................... Disposal Field: Distance from nearest well...............-Distance from foundation....................Distance to nearest lot line.............. Number of lines.-.__------------------------- Length of:eech line ....................Width of trench.......................- - Type of filter material.........................Depth of{flier a l................ .Total length..........................____._... may,. i . Seepage Pit: Distance to nearest wellc%rx......DistanWt ... Q.-.....D1sta�ce to nearest lot line-1.6_10-- Seepage Number of pits_........--------.Lining mater �Cesspool: Distance from nearest well.`...-.........Dist -------------'.....Lining material.................... ❑ Size: Diameter ......._ ......................Depth"'--~------------------- -....................Liqu d Capacity....-----•--------._._gals. Privy: _ Distance from nearest well.......................___--------.----------Distance from-nearest building......................._............. ` •Distance':to nearest lot line._'...s_...:.............».- . ,Remodeling and/or repairing)describe)c...-------.............. .. .............:......._: _...._......-........-----........ ... - -` ._... f at _. - L. 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ,_. ordinances;S •law end iu es endo eguletions of +Xe 5an'Joaqum Local Health District. (Signed)..- ... . . .:. ... ... ....... ... -.. ... ..- ..:.._......._...................._...-.,_...____- -__ -antractor) Byi... .. .. .. .. ... .. .. ............--------------'........-----------.......-------(THe) ^ ........... (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........ ..:..........� _ .x DATE._-..jC.-._...-.........--........._....._......_ REVIEWEDBY--------------------- - ... - - ...._------.........................._ DATE - - - - ....._..........- BUILDING PERMIT ISSUED...................... .......... .......... `.ee1 ......._ DATE........-.... f .-.. Alterefi rn;and/Qr recom nondations:._-----------------_.- -- -- .... . -------- ......_............................................_.---*---- ---.,,.......----..........., ---------...-•-------------------------------------.-_.._-----._.-------•---- ....._....-:: ................................ -------------------------...........................................................-......................................................-......................_... _--------------....................................---------....................................-.........----..._.......................-.......I--------------....................---------...................._._... - ..................-........... .....-...............................................-------......................................-........................ . -----------------.................................... FINAL INSPECTION" BY:. .. ..... --... Date._ --.... ........ -------------................................ i SAN JOAQUIN LOCAL HEALTH DISTRICT t30 South American $had 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California ' Lodi, California Manteca, California Tracy, California ,