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►°, � APPLICATION FOR SANITATION PERMIT Permit\4. (Complete in Duplicate) r Date Issued 1------ � Applica}ion is he made to the San Joaquin Local Health District for a permit to construct and in5talll the work herein described. This application is made in compliance with County Ordinance No. 549. 1'f 3 " 1 JOB ADDRESS AND LOC TION f-__ --- Owner's.Name._ --------�! -------------------------------------------------------------- ------------ Phone------------------------------------ -------------- Address--------- --;-----•----- f--- C Contractor's Name. -------- Installation = ,'- �P -------------- Phone.... Installation will serve: Residence rl Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms --------- Number of baths _,-_" Lot size _" ��_.�.-`"-�re-----------------------•- 01 Water' Supply: 'Public'system 18" 16ommunity system E] Private [-] Depth to Water Table eft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam.❑ 'Clay Loam ❑ Clay ❑ Adobe It-- ardpan ❑ Previous Application Made: Yes ❑ No .New Construction: Yes ❑F No �' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet'.) f Septic Tank: Distance from nearest we%I_��Qistance f om-foundation___ �---_____.Mat�ia�_ /:_��Ff'. ___. .�______________ No. of compartments-----t3-----------------Size---� -X._ ---Liquid depth.--- Capacity--- - �+f�------ -0 -Z Disposal Field:,i Distance from nearest well./4V-?`Distance from foundation-v, _.._____._.Distance to nearest lot lin... .......... Number of lines---------- --- "----- - �Length of each line--- :-----------.Width of trench.-- -------------------- Type of filter material" ^ .,Depth of filter material___. ..___-Total length........5?? ---------------•- --- Seepage Pit: Distance to nearest well_-_' ' "-Distance from fou411ze: tion____ .._.__..D�st � to nearest lot line---- Seepage Linin material Diameter__. , _-"-"___Depth------- -------------`\ Number of pits_-__.�""-"."--�- g' Cess: .� Distance from nearest well----------------- from foundation___________________Lining material_.______..__..___________._______._ ials. ❑ Size: Diameter----------------- ----_.Depth---------------------------- Liquid Capacity 9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.__-_--___-__________________----_-----. ❑ Distance to nearest lot line-----"------------------ --- ••----------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- ------• --------- ------- - - I hereby cerfify that I have prepared this application and that the work_ will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. -• ' - �r Contractor) (Signed)---------- ------ .----- X-- ---`-� 6 . � ------------------- (Plot plan, showing size of lot, 10 in of system in relation to wells, buildings, etc., can be placed on reverse e). FOR DEPARTMENT USE ONLY F L APPLICATION ACCEPTED BY----------- -------- --- - ------------------------------------------------------------- DATE..... ----- -- REVIEWEDBY------------------------------------------------------- -------------- -------------------------------•------------------ DATE--------------- - BUILDING PERMIT ISSUED-------- -----------------C:-- -• " ------------- DATE _' -------------------------------- l - - Alteratians and/or recommendations:__. .-....--_... ----------------- L - ------------•-- --- --- . ---------- ----- - ----------- ---- -------- •-- - ----------------- FINAL INSPECTION BY:__ --------5- -- Date__.._-_.�.._-� �7 ----- ............. SAN JOAQUIN .LOCAL HEALTH DISTRICT 130 South American Streot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy. California E5^�9 i 5444 ATWRDD