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APPLICATION FOR SANITATION PERMIT Permit No. _ {-��f-- (Complete in Duplicate) Date issued Applica%n 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 .Coupty Ord' ante No. 549 Y -r------------••------ - -----------------•--- ---- ----------- -- Os ,5 JOB ADDRESS AND L CATION____._____ _ ----.- ,�� Owner`s Name------- - •--•---------------------- ----------------------- Phone__!C "_-- - fy� --------------------- Address................ `" .`-------------------•---------------- Contractor's Name Phone�z-- '",- •--. Installation will serve: Residence ( Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: __f____ Number of bedrooms _'Z-_---Number of baths J---- Lot size ___ ____ __ ._ - ---------- Water Supply: Public system 7�- Community system ❑ Private ❑ Depth to Water Table' .Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application-Made: Yes ❑ No 54-- New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.` Septic Tank: Distance,from nearest well-A/-1).,�r4.rDistanc m foundation_/4:___.____:".Materials i--------------------- No. of compartments_.___---------- Size__s� - -*~�Ir►----Liquid depth----- .? ------......CapautY----- dZ�------- Disposal Field: Distance from nearest well_A?7•+�-Distance from foundation__...____.Distance to nearest lot r Number of lines---------/--.-- « -------Length of each line-------�©----rt---Width of trench-- '- -------------------- l De th of fif- 1. ._ Total length--_,�'4P----------------------• T e of filter material-�_ p Seepage Pit: Distance'to nearest well Dist e fr m foundatio _ .___..Distance to nearest lot line-__/10_.-___ Number of pits.-___---"----- � �S�i iameter--- �#e/_ _De t'n--- �Z f --- Lining m erial. p Cesspool: Distance from nearest well "_.__Distance from fo ation------------------- Lining material----------------------------__------- . ❑ Size: Diameter----------------------- ------------ th---- ........Liquid Capacity----------------------------gals. earest well------------------------"----------------------.-Distance from nearest building----------------------------------------- Privy: Distance from n❑ Distance to nearest lot line------------------------- --- ----------------•-------------------------- -•-------------- ---------------------------- r . . . -- `odelingfand/or repairing (describe):--------- - •-•----------------------------------••-----•--------------- --------------------------------- ---------------------------------- y { -----------•------• -----••--------------•---------- - --------•--------------------------------------••----------------------- -----------•------....------------------•-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I w , nd rules and regulations of the San Joaquin Local Health District. (Si:e - - --- ----------------------- -------------------------- -.__(Owner and/or Contractor) P -------- By:_ 2 ---------------------------(Ti#e) = ._. ry (Plot plan. showing size of to+, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - .......... -------- DATE-- - -------------------------------- REVIEWED BY DATE--- --- BUILDINGPERMIT ISSUED----------------------- --------- -----------•-------------------------------------------- DATE-------------- -------C--- --------------------------- Alterations and/or recommendations:. �". -------------•-----•- -----•---- •- ... ..........y - - --F"/----- - -- •------------ ---...--------------------"------- •--------•----•-----• ------••------...---•- --------- - - - -- « --- ----------------------------------- - -� ----------------------------------- - -------- ------- ------------------------------------------- --------- ------------------ ----------I-------------------- FINAL INSPECTION BY:----- -------------------- Date......f.)_ _/-.-�- - ------- 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 CP ES—9-2m—2M 145456 A7WOoo 12-54 -