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APPLICATION FOR SANITATION ' .:AMIT Permit No. ......':i---------------- (Complete -----_ ----(Complete in Duplicate) Date Issued ------: Applica�ion is hereby made to the San Joaquin Local Health District for a permit tc��ir Eruct land in's ll;4hekor /,kerein yiescribed �_ - This application is made in compliance with County Ordinance No. 549. ! : '�-* ' !d w - / F JOB ADDRESS AL AT 10 r .. -- -- r / Owners Name........-- E .:� ----- 1 � ------------------------ `. Address.---- ----------------- r,—. ------- --- - o Contractors Name------__�. '_._._z--------- -- � t Installation will serve: Residence p--Apartment House �] Commercial. ❑ Trailer Court ❑ Motel ❑ Other �-��' Number of living units: --.- -- Number of bedrooms -------- Number of baths ....---- Lot size .__... :-- Water Supply: Public system ❑ Community system [IPrivate [�epth to Wafer Table -._._.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q_-Hardpan [ .previous Application Made: Yes ❑ No M---'New Construction: Yes U0--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: y_,-(No septic tank or cesspool permitted if }public sewer is available within 200 feet.) t j Material ------- ---------_1_1------------------- S� tic T Distance from rearest wail..... _.. Distance from foundation____._____-..._- -. No• of compartments... Size------------------ Liqu d dep.f - - Capacity �.-4�--�--...Distance to nearest lot line--,/----.,.-_ D' al��elr�— Distance from nearest welt --. Distance from foundation.---. - /ter Widtfi of trenth: _i'-' Number of lines---- _-._.-- i. _•- Length of each .. �:r----------------- T e r -._..Total length_...- ?' YP �� i=�� Depth of filter material___ �� Type or filter mater�aF ._, Seepage Pit: Distance to nearest well..___ _-..._._.----.-Distance from foundation-------------------Distance to nearest lot liner------------- El Number of pits...........----------- Lining material � Size: Diameter Depth. Cesspool: Distance from nearest well__..--_._....._.Distance from foundation-___...__._.-..__ Lining material........................__._..._. Capacity ------------9Z I r_1 Sze: Diameter-----� - --------- --...... - Depth. --- - ---- --------- ----.--------'----__.Liquid Ca P Y------------- - - Privy: Distance from nearest well-----------------------------------------------'-Distance from nearest building.---.-- .--------------------- ❑ Distance to nearest lot line-- - ------------ - -- ---- --------------------------------------- -- --------------- ----------------- ------ -----------------------------•-- Remodeling and/or repairing {describe)------------------- --------------------------------------------- ---------------- ------ --------•--------------• ------------------ ------------------------- ............ ------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coul ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. NIGHT l wzeu. aad/or Contraci (Signed)- --Sereix._Tarik- 'uice-------- ------------ --- 1206 - �. t2Q6 So. Eldorado ttU 2-70,46 '` Title �' < i3 :_ (Title)---- y -------------------- q �I=r �;; e;i: (Plot plan, showing sire of lot, location of system in relation tg' ells, buildings, et can be placed on reverse side). FOR DEPARTMENT USE ONLY ... DATE--- ---- ------=--- --- ----,. APPLICATION ACCEPTED BY----------- --- - '. F DATE-.-.-. ----- --------------------- BUILDING PERMIT ISSUED------------------------ ----- ----- = ------ REVIEWED BY------------------ ----- ----------- ------- DATE -�-�- ---�-- ---- - ------- - ----- -- ----------- ---- Alterations and/or recommendations:--.----- '-- - ------ --------- -------- ! i , I FINAL INSPECTION BY: ------------ --- --- -- -- Date------- ....._...... ... ... "- -- ......... ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South Amorican Street Trac California € Stockton, California Lodi, California Manteca, California y f