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APPLICATION FOR SANITATION PERMIT Permit No. �'``! (Complete in Duplicate) /p l� Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and inst II the work herein described. This application is made in compliance with County Ordinance No. 549. �d-S--- [o—,o,/ q(0 24 tfCCO73-C c i fJ JOB ADDRESS AND LOCATION---- Owner's Name----- }� -- ,� dT� ----------------------- -------- -----------:---------------- Phone Address------------------------- -�?C--d ---/ /-r------------------------------------------------------ Contractor's Name------ =_ a-•- -- ---- Phone_ Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer_Court E❑ Motel E] Other )] __ Number of living units: /--- Number of bedrooms a_. Number of baths _/.- cot size ------Fy------__ Water Supply: Public system ❑ Community system ❑ Private ;ML Depth to Water Table & ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No V+"_ New Construction: Yes b�5,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-- ---Distance Distance from foundation----/,l -_-__._ Material__-- ___-____-__ 1] No. of compartments----�-----------Size---s - �--Liquid depth-,--�j_G?-_ _.........Capacity... ---- Disposal Field: Distance from nearest well_ �J.f_._Distance from foundation__ _r--,:_rDistance to nearest lot line----A Number of lines___.__._-__&,-,,,-Length of each line__.__ d:` 9_Width of trench..._. - r I �- yp -Depth of filter material___,1- T e orfilter materia ,...__-.__Tota# length------ Seepage Pit: Distance to nearest well &,O--------Distance Jrorn foundation----f_: L7istance to nearest lot line... 9L Number of pits-----�_---------Lining materiaLm Diameter._._. Depth_- r-----_.--- Cesspool: Distance from nearest well--------------_-Distance from foundation- .----__._:-_--..Lining material_-_-___..__.__---___._. � ❑ Size: Diameter-------------------------_ ---------Depth----------------------- .-- ------_.Liquid Capacity- ----------- --------------gals. Privy: Distance from nearest well------- --------------------------------------- -Distance from nearest building-------,------------------------- ❑ Distance to nearest lot line--------- - ------ -------------------------------------- ---------- ------------------------------------------------ -- ------------- Remodeling and/or repairing (describe):----------------------------------- --------•--------------- •----------------- --•------------ ---------------------------- ------------------------------------------------------------------•------------------------------------------------------------------------------------•--------------------- -------------------------- ------ -----------------------------------------------------------------•---------•-•---------•---------------------•----------------------------------- ------------------------------= = ------------------------------------- t -------------------------- -------- -- ----------------------------------•---------•---•--------------------------•---•-------------------•------------------------------------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfat and ruled and regulations of the San Joaquin Local Health District. k 'v {Sd)------- ---- ------------ -------------------(Owner and/or Contractor) . e -- B : (Piot plan., s owing�s_izeflot, location of system in relation to wells buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------- ---- --------------------------------------------------------- DATE-- --6-••---. -- REVIEWED BY ---- --- - --------------- DATE------------- a BUILDING PERMIT ISSUED------------- --------- = -- ------------ ---------•--- -------------------------•----------- DATE-------------- ----- Alterations and/or recommendations:_-__-.......... .... \ ---- ------- - ---------- ------------- -------------------------•--•-------------------------. --------- ---------f-----•---- FINAL INSPECTION BY:----,�u- s------------ --------------------- 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 145446 ATWDDD