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APPLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in.Duplicate) . .. Date issued _____��-,3J•-�' Application is hereby made to the San Joaquin Local Health District for a permit toconstruct d '3 8ll th or ere: escribed. This application is made in.complian ith County,Ordinance No. 549. 1 7b8 £- C9 �r 6.4c_d I A-✓ .. � # �. � JOB ADDRESS AND LOCAT ,, r Owner's Na e , - -- -------- .- ._. - ------�:-....-�s�.--,--._------------ --- - Phone.---`�- Address..__ "� --------- ---------- Contractor's Name__ -----_- Installation will serve: Residence A Apartment Hous Commercial . ❑ Trailer Court ❑ Mogi ❑ other ❑ Number of living units: J--- Number of bedrooms _ NumVD f baths -_ of size __ -_ -- --- - ----------------------- Wafer Supply: Public system ElCommunity system ] Privateepth ;",-Water Table -------- ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sand Loam t y Clay Loam ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No V New Construct ion:.,Yes,No [' -'�* .. `b I TYPE OF INSTALLATION AND SPECIFICATIONS: oc 1 (No septic tank or cesspool permitted if ppublip sewer is available within 200 feet. Septic ank: Distance from nearest well-0._______ Istan e fro ffountion r.�_�i. I T ri�71 _P- c No. of;'cornpartments----------�._fr------Size_, �,_-_ _-ACCO---Li}quid depth..--- ------------Capacity---- Q-- Dispos�l Field:f4:F �DisianceJfrom neare4weV_- :lance from foundat'o _-_�- _ :stance to nearest o rheNumi�er of limes_______ -_____ _ Length of each line-' .�____ _ Width of trench_.__ Type of filter mater '� epth of filter material__.--__ C-__--Total length_--___ __ _� y + --------------------- eepage Pit: Distance to nearest well-______________ ---------------------Distance from founda#ion __________Distance to nearest lot line-____.-_�____-.__ ❑ Number of pits Lining material -Size: Diameter-----------------------Depth-------------- ------------------ Cesspool: Distance from nearest weiL____------------Distance from foundation_---- �77--' :nga erial_____---_______-_____------ ❑ Size: Diameter--------------------- . Dept h a#' mA T --- -Liquid Capacity ------- __gals.Distance from:nearest well--- ---------------------------------------------DistanArom 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 County IN ordinances, S';fafe laws, and rules and' regulations of the San Joaquin Local Health-Distric+. _ s 1 (Signed)---- -:_. f%__. t----------------------------------(Owner and/or Contractor) N By: -..• ---_..------ i.� - ------' ----- (Title} (Plot plan, showing size of lot, location of system in relation +o wells, buildings, etc, can be placed on reverse side}. ------------ r FOR DEPARTMENT USE ONLY,,. APPLICATION ACCEPTED BY ----------- ------------------------- ----- DATE-j ' ------------------- �*'' -------------- REVIEWED BY ---------------------------- - - -------- DATE----- ----------------- BWLDING PERMIT ISSUED__________--- i --------------- -----•--------------•---•-.----- --- --• --•-------------- ------------- ----------•----------•----- --- i ------------------------------------------------ FINAL INSPECTION BY:.-___-_--_-- .------i�-- ? Date. ---- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+reef Stockton, California Lodi, California Manteca, California Tracy, California ES=9-2M 10-52 Revised W=210o