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APPLICATION FOR SANITATION PERMIT Permit No. . ......------ (Complete in Duplicate) 0Y7 Date Issued .......7P._ Applical-ion is hereby made to the San Joaquin Local Health District for a permit to construct and. install the work herein de.scribed. This -application is made in compliance with County Ordinanc. No. 549. >a - ---------------- ------------------- JOB ADDRESS AND ------------ - --- ....... 1_�ATION---- n ------- Pho -- --- -------- Owner's Name. - - --- ------------- Address...... - ------------------- --- - - ------ -- ----------------------------------------------------------------------------------------- ------------- Contractor's Name-------------- ------------ ---- ---- --- -----------------------------------------------------------------------------------:--- Phone---.... Installation will serve: Resi nce Apartment House Ll Commercial E] Trailer CourfAl Motel [] Other El Number of living units: --- --- Number of bedrooms Z-. Number of baths --- Lot size ----------------- Wafer Supply: Public system Community system 0 Private Ej Depth to Water Ta Character of soil to a depth of 3 oaf: Sand F-1 Gravel E]I Sandy Loam [I Clay Loam [I Clay ❑ Ad ObA Hardpan ❑ h-j Previous Application Made: Yes [] N0 New Construcfionl-'�Yes S/V No D TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well-----------------Distance from foundation--------- ----------Material------------------------------------------------- No. of compartments--------------------------Size--------------------------------Liquid clepth--------------------------Capacity----------------------- OD'6pos Fi Distance from nearest well___-------------Distance from foundation--------------------Distance to nearest lot line______________--_ ,j� 4D po' Number of lines----------------- ---- ------------Len/gth of each line--------------- -----------._.Width of trench----------------------------------- Y rench----------------------------------- ----------Depth of filter material-----------------___..Total------------------Total length------------------------------------------ Type of filter material----------- 14 it, nce f rr ..-..Distance to nearest lo,1�1' a---- SeVepa it, Distance to nearest well _Distance �ou Size- -&�------ I -- - -v-, ameter-__7----------------Depth Number of pits.../------------- Lining material I vor from Cesspool: Distance from nearest well------------------Distan e from faundation....................Lining material-------.----__.____.____-____.______ Size: Diameter---- ------------------------ -- ----Depth------ ----------------------- ----------------Liquid Capacity----------------------------gals. ,6El Privy: Distance from rearest well------------------------------------ ------ --Distance from nearest building__________.__.-_---_--__-_____.._._______- N, 7 -- --- --- ElDistance to nearest lot line--.�---- -- ----- -------'--- - -------- ----------------...... -------------------------------------------- ----- - --------- • ------------------ Remodeli ai Idescribe):-------- - - ------- - -------- - ---- -- ----- -- ---- ---------- Z --------- ------------------------------------------------------------- --------- ------•-••---------••---------•-----•--------------'- -- --- ----------------------------------- --------------------------------------------------------------------------------------------------I•-------------------------------------------------------- -I ------- --------------------------- ----------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ ---- --------- I hereby certify ih I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State is an rules a r ulations of the San Joaquin Local Health District. 'r- (Signed)--------------------= ---- - -- ----------------------------------------------------- --------- (Owner oWzr Contractor) By:-------------------------------------- ------- --.--------------------------------------(Title)---- --- --- --------------- (Plot plan, showing size of lot, loc ion f system in elation to wells, buildings, etc., can be p on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- DATE-5r-------------------------------------------------- REVIEWED BY------------------ ---------- DATE----;----'? c------------------------------------------------ BUILDINGPERMIT ISSUED-------------- - ------- -------- ---------------------------------------------------------- DATE----- ( -N ----------------------------- Alterations and/or recommendations:--- ----------- -------- ---------- ------------ 'A------------- -- ----------- - ------- - ----- ---- ---- ------------1-�,�- - �------ ------ --- ------- :------------------------------------- ---------------------------=� - -e�. . ..... 40....... . - - - --- ---------- -------------------I-------------- ---- ---------------------- ------------ ---------- .. ...... . -----------------1:------------- ---- ----------------------- -------- ----- ------------------------------------------------- ail - - --------- ----------- ---------- cc------------------------- ---------- ----------- ...... ------ -------------------- - - --- --------- --- -- ----- rJ FINAL INSPECTION --------------- --------------- Date-------- ------------------------- 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 ES---9-2M 145446 A7WOCD 12-54