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►11� '' � APPLICATIQN FOR SANITATION PERMIT Permit No. __. --�••- (Complete in Duplicate] Date Issued A lira*ion is hereby made to the Sa I Joaquin Local Health District for a permit to construct and install the work herein described. Thiisapplication is made in compliance with County Ordinance No. 549. -------•---•------------ ---------- A? ---•------- JOB ADDRESS AND.LOCATION.-___. __�-.� ------ - ---------- Phone_ _ --------------------------- - f Owner s Name------------- --------- Address-------------------- ----- ----- --- 1� ��,� -------------------- --------- --------------- Contractor's Name Phone_ ._ Installation will serve: Residence Apartment House ❑ ❑ / Commercial Trailer Court ❑ Motel El Other ❑ Number of living units: __� Number of bedrooms _.-� Number of baths __1_ Lot size l�-1- Cf �d-------•-------------- Water 5upplyc"'Public system Community system ❑ Private ❑ Depth to Water Table __yam ft. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loa ❑- Clay ❑ Adobe[Hardpan ❑ Previous Application Made: Yes ❑ No [j}�Nlew Construction: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . .s . Material Capacity". - �. pti k: s Distance from nearest well-----------______Distance from foundation_____________i._ ._. No. of compartments---- -- ---------------Size----- --------------------Liquid depth--------------- sppsal d: Distance from nearest well................^Distance fro m foundation_____________;.____.Distance to nearest lot line____._______.__.. Number of lines------------------------------- Length of each line:--'----------- Width of trench -------- Type of filter material------------------------- epth of filter material_----------;---------Total length----------------------------- Distance to nearest lot line--__- D•sstance f om fo ndation__._ `-�-- l Seepage Pit: Distance to nearest well-_/w --- i� Linin material__F --Size: Diameter_..33----------Depth____�`�----- --- � € Number of pits------f------'----- g Cesspool: Disfiance .from nearest well________________Distance from foundation---..:_:- Lining material________�,------------------------- Cesspool: ___..______._______ - __ ❑ Size: Diameter------------------ ------ --- --------Depth--- Li uid`Ca acit gals• ------- ------------------Distance from nearest building----------------------------------------- Privy: Distance from nearest welL____.,_.-------------- ;;/ ---------_--_- --- - --------------- Distance to nearest lot line..___._____________ __ , - -- ---•------------------------------- I - Remodeling and/or repairing (describe):------_-------------- ------- ____`_____________4________ - ____________________________________________ ___________________________________ - -----------.. -------------------------------------- --------------------------------_ __ ______________________________________________________________________________________________ _ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . 1 ordinances, to laws, and rules and regulations of the San Joaquin Local Health District. t I { a ner and/or Contract i ------------------ -----------Si ned --•-- ---- ------------- :I - ------------------------ (Title) �. sy: . (Plot plan, showing size of lot, location'of system in a#ion to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY -------------------------- DATE---------- --••-- -------------••--------------------- APPLICATION ACCEPTED BY_______ ---�--------- ----- ---- o----- ` r - ------------------- DATE---------------•--•--------•---•---------------------------- REVIEWED SY .... -- ._.---- ----------------- DATE = BUILDING PERMIT ISSUED-------------------=--- _ _ _ - Alterations and/or-recommendations:___---------- ------------------------- - - ---- - ----------- -------------------------------------- _ _._ :.. ----- -- --- - c . - ---- ------------------------------------ --------- - - Date -.6. �` - -------- ---------------------------- FINAL INSPECTION BYi-___--- ----'-- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street in Sycamore Street 814 North "C" Street 130 South American Street Tracy, California Stockton, California Lodi, California Manteca, California Y� r5--9-ZM 145446 A-c- 12-54