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Permit Na. APPLICATION FOR SANITATION PERMIT I (Complete in Duplicate) Date Issued --�- --y-{-- v ti- V Application 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 County Ordinance No. 549. JOB ADDRESS A ; LOCAT ----- Phone-----Owner's -- -- _ `.,._» El Address- -------- r t r17 ------ - - ----- ' Phone Contractor`s Name-------------------- ----t -------------- Installation ------------ --- ------------------- --------------------------------------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ .Trailer Court ❑ Mote; ❑ Other Number of living units: ___/__ Number of bedrooms - - _ Number of baths ----1--- Lot size ____ -------------------- Water Supply: Public system [Community system '❑ Private ❑ Depthigto Water Table -------- ft. of 3 feet: S;�ONew Gravel ❑ - Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Character of soil to a depthu Previous Application Made: Yes ❑ No Construction: Yes No" ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: / (No septic tank or cesspool permitted ifA-4ANDistvce blic se-er is available within`;200 feet Septic ank: � Distance from nearest wellfr fou �tion_____�___ __ --.M eirial-- -------------- ---- ---• - --- � ize .- _ -_;_Liquid e�th rT Capacity {� f LY'1 No. of compartments__ -___ _ ---- r-� Distance to nearest lot line . ('Distance from founds • n _�_-_ _--_,_ �7 � Disposal Field: Distance from nearest well____ I ..0 Width of trench_--____Z-7 ------- -- Number of lines______------ -- ---.---- Length of each line---- -- if----- © Total length-- Z_ � --- Type of filter material!?_ _: epth of filter materlal______i✓_ _____. Seepage Pit: Distance to nearest walk________________ _Distance from foundation.__________________.Distance to nearest lot line------ " ❑ Number of pits---------------------Lining material-----------------------Size: Diameter------------------------Depth-----,--------------------------- Cesspool:. Distance from nearest well___-_-___._-____Distance from foundation---------------_----Lining material_________________-__-------------- ❑ -Liquid Capacity-------------------------- 5ize: Diameter--------------------------------------Depth------------------------'--- ------------------- gals. Privy: Distance from nearest well_______---______-_--------------------------Distance from nearest building________:.------------------------- El Distance to nearest lot line ________________________ .� --- ---------------------------------------- Remodeling and/or repairing (describe)------------------------------------------•-----•----•------------ ----•--..-------•----- •--------- ' -------------- --------------- -----•---------------••-•-- ----- -----------••------------•------------•-•-----------------•---------------------- co •----••------ ---------- -................... - ; ____ - ---------------------------------------•----------- in I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun ty ordinances, State laws, and, rules and regulations of the San Joaquin Local Health District. i (Signed)---- Al AE' ------------------------------------------(Owner and/or Contractor + ".. (Title)---------------------- ---------------------------------- By=------ .- --------- ----------- ------ - = (Plot plan, showing size of lot, 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- -^� t DATE------ -fie-------------------------------------------BUILDING PERMIT ISSUED-------------- --------------------------------------------- E 46 t--------------- a-1 4 ------- -- I_te tions and/or recolendations:--------- - -- ----- ----------------------------------- --------- - �. ----------------------------------------------------------- ------------------------------------------------------------ ------------- -------------- j INSPECTION BY:--------I {------------- Date ---------o -V ---------------------------------------- FINALii SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132'Sycamore Street 814 North "G" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California Y. i ES-4-2M 8-51 Revised W-2100