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APPLICATION FOR SANITATION PERMIT Permit No. .......74IIA- [Complete in Duplicate) Date Issued A -ion 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 4 OL compliance with C-o-County- Ordinance No 549.p JOB ADDRESSKND LOC �ION A - - ----- ------------- ----------- ----------------------------------------------------------------------- Owner's Nal, ----- . ... . - - ------- - - '---- - ------------------------------------- -- Phone-----------•-•-------------- Address hone----------------------------Address---- -l.9----Au,0 -) 1.- 4- ......... ------- -- - - -- - - ---------- ----- ----- -- -------------- --------- It - - ---------------------------------•---------------------------I-------------------------- -------------- Contractor's Name--- ------.ii----------- I --- ------------------------------------- ------------------------------------------------------I------------ Phone------------------------------------ Installation will,terve: -Residence Apartment House E]. Commercial [-] Trailer Court E] t&tel Ot Or I Number of living A J---- Number of bedrooms ----/'�Number 6f baths I---- Lot size I - - Water SUp�Ply'.' Public syste'111 - Community system [] Private 0 Depth to Water Table -------- ft. Character of soil to a depfh'of 3 feet: Sand M Gravel E] Sandy Loam �k Clay Loam E] Clay E] Adobe 9--`Hrdpan [3 A Previous Application Made:ill(es Ej No 21New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: I Distance from nearest well------------------Distance from foundation.--------------.---Material El l No. of clompartments-----------------------.--Size------------------ ----------Liquid depjh--------------------------Capacity----------------------- Y. Disposal Field D;stanceIf'o m nearest well-- ----Distance from foundation--------------------Distance to nearest lot line.----_------_---_ Number I ,pf lines------------------------------- -Length of each line----------------------------Width of french-------------------_"_"-- r , S ---------- TYPO OT filter material-------------------- ----Depth of filter matel-----------------Total length------------------------------------------ Seepage Pit: Disfa'nce to nearest from' -foundafion--------------------Distance to nearest lot line--.----___--__."" El Number' f pits----------------- Lining material--------------------_ -Size: Dian)efer------------------ Dept' ---------------------- I li' /,�, ---- 4 Ce Distance from nea f we Fwpl ------ - -- L —Distance from foVadatiol ining material-- -------------------- A Size: Dia efer---- ------------------Depth----------------1::9 -------------- -- ----------------- Liquid Capacity----------------------------gals. Privy: Distance' from nearest well------------------------------------ ---------Distance from nearest building-____--------_----------_-__"_""--_"- ❑ Disfance�io nearest lot line ---------------------------------------- - --------------------------------------------------------------------------------- - - ----------- - )- Ren o'delil and/or repairil ��,6e,. ------------ - -----•-------•--n-----------------------•--------•"---- ---------------n---------------------------------------------------------------------- ---------------- ...... . ... ...... ........ ---------- ...k..y---C4---------------------------------------------------------------------------------------- in A- ------ --------- ... .... .......IrA 17-----------n------------- FI - ------------- ------------------------------ -------- #f 44 -------- ------------------------- I here y certify t I�af I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, an "Ules and regulations of the San Joaquin Local Health District. x) - - [Signed) ' (Owner and/or Contractor)_ Bq:-----------------------------I-------------------------------------------------------------------------------------------------- (Title)--------------------------------------------------------------- (Plot plan, showing size of lot location of system in rill to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- DATES _ REVIEWED BY------------------------0 ---------- 1pt -------------------------------------- DATE_- --------------------- ------------- ------------------------- ------- -------------------------- - BUILDING PERMIT ISSUED.-O------_ ---------------------------------------------------------------------------------- DATE--------- - ----------•------------------------•-••------ --- Alterations and/or recommendations:............... ----------------- ----- --------------------------------------- 1111 - -------------------------------------------------------------- ----------------- ------------------------------------------------------------------------- -------------------------------------------------------------- ------------------------------------------------!1K------------------------------------ ------------------------------- ------ -------------------------- ------ ------------------------ ----------------------------------------- ------------------------------------------- ------------------------- ------------------------- ----------------------- -------------------------------------------- ----------------- --------------------------------- ----------------------------------------------------------------------- FINAL INSPECTION BY:.K-15�1-V5 -- ---------------------------------- Date......../-��------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street I 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California i Lodi, California Manteca, California Tracy, California Er-9-2M 145446 AT-D 12-54