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Permit No. APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) / ;I Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described, .' This application is made in compliancepith County Ordinance No. 549. 0 L 0_0 L{ JOB ADDRESS ANj�O�C &TION- D �""'`'�'------------------ ---- ------- --------- --------------_. Y Owner's Name =-----•- --------------- Phone.-- ----- Address...............�.�---�_.�� ------------ --- Name-------------------- --------=---- ---------- - ---------------------------------------------- Phone----------------------------------- 1 Installation will serve: Residence j artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ y � Number of living units: I__._ Number of bedrooms ___ _._ Number of baths ___1___ Lot size,�_/l�_O.x_j.'�_�_______________________________ Water Supply: Public system E] Community system E] �r-svate O , Depth to Water Table _,N� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑.. Sandy Loam ❑ Clay Loam ❑ Clay Adobe E] Hardpan [IPrevious Application Made: Yes ElNoX, New Construction: Yes No E] { TYPE OF INSTALLATION AND SPECIFICATIONS: Se ti Tankse tic tank permitted if public sewer is available within 200 feet.) [ p ' e _ J p from nearesr well__,-b'��___--Distance from foundation__.__]__"-2/---_.Material____ ._ ______�`a+'�J. No. of eompartments---- =Size q i? Capacity.'.. O' �Q_ �_�!_?C__ JLi uid de th___ �� Disposal Field: Distance from nearest well..50-_.._Distance from foundation______�-Q_..._Distance to nearest lot line___1 of lines___.__ . ______________ ___Length of each line4j.0 —<4)Vidth of trench Number __ / L�i1 Type os filter material.-_ 7Y C .Depth of filter material___ '-�r„To+aI length---------d._r,�_0____________________ Seepage Pit: Distance to nearest well____--------------____Distance from foundation________________-_-.Distance to nearest lot line-._______________ ❑ Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Dept h_._.__._______.____-____._____- Cesspool: Distance from nearest weld-----------------Distance from foundation-------------------.Lining material___----------------------------------- Size._Dlameler.---------------------------------------Death__-_,_.,_ _— — �u' aPa ;gals. _ Privy: Distance from nearest well-----___-------------------------__--------------Distance from nearest building----------------------------------------- 0 Distance to nearest lot line------------------------------ ------------------------------•---•---- -- •--- -------------------------------------------------------------- k Remodelingand/or repairing (describe):---------- -------- --------------------------------------------------------- ------------------•-------------------------------------------------------- r ------------------------------- ----------------------------------- -----------------------------•--------------------------------•----•-••--------•-----------------------•-------------------------------- I hereby certify that I;'have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulesa gulations of the San Joaquin Local Health District. (Signed)-- --•-------• -•------•-----------------�-- - -- ----------------:----- - - -- -- -------- ----------------_-------------------_--------{Owner and/or Contractor} By:-------------------------------------- --------------------------------------------------------------------------------------- -----{Ti+lei---------------------------------------------------------------- (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 -- --------• DATE---------- ------- BY------------------------ --------------------------------------------------------------- DATE------ ---------- •------- --- ---------��-------- REVIEWEDACCEPTED- ----------------------- ------�.------- -- - 4 BUILDING PERMIT ISSUED,------------------------------------- --------- DATE.-------- ---------1------------- ------------_----- .. Alterations and/or recommendations:-------------------- — ---------------------------------•--------•---------•----------- ---------------------•------------------------ -------------------------------------•-------- ------ -------------------------------------------------------------•-----------------------------------•------------------- -- •----- ------------------------------------------------------------- ---•-•-----•---------------------------------- --------- -------------- -- --------------------------------------------------------------- Ir FINAL INSPECTION BY=-------- ----- -------------------- - ---------------------. 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�ATWOOO 12-54