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E APPLICATION FOR SANITATION PERMIT Permit-flo.'__ °" '................ f in Du plicate) �,✓7th a`!C" (Complete p } Date Issued ---•-----------�----•-- oApplica4ion1s 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. 544. JOB ADDRESS AND L TION______""-___-- � , --------------------- --- P on Owner's Name- _-... --------- - --� Addr _ d----------------------- Contractor's Name-------------- - -•-• ------ -- - - - ----�----- '�`� - ----- -------------------------------------------- �e._�p _s. -� _.. Installation will serve: Residence ; Apartmentrouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of baths _ ._ Lot size ---- - --- ./-- ----•----------•------- Number of living units: __I""- Number of bedrooms � � � Water Supply: Public systeCommunity system [IPrivate ❑ Depth to Water Table 441. Character of soil to a depth of 3��``feet: Sand ❑ Gravel ❑ Sandy Loam El_ Clay Loam El Clay E] Adobe)kr ❑ Previous Application Made: Yes ❑ No k New Construction: Yes No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Material ----�� _ ----------- Septic Tank: Distance from nearest we I"" Q. ---Distan a from foundation ____-""--- r Y-144-Liquid depth--r---- -- -------Ca . No. of compartments--------------------------Size_-.IY� _ �!' isposal field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- Length of each line------------------------ Width of trench---------.------------------------- Number of lines---------------------------- g --------- ----------- of filter material---------- length------------------------------------------ Type of filter materia Seepage Pit: Distance to nearest well,)��-,"------Distance from foundation_10- -""" Distance to nearest lo# Gne_._ ___ Number of pits--,-/---------------Lining material- -, ----------- -----Size: Diameter____,-'--- Dept -.-------Dep 'n___ _I_ r2__ i 11. -" Cesspool: Distance fi,om nearest well-----------------Distance from foundation....................Lining material__ --------------- ------------------ Depth--. Liquid Capacity-.--------------------------gals. ❑ Size: Diamefier---------------------------�-- --�-- p r Privy: Distance from nearest well.------------------------------------------------Distance from nearest building---------------.------------------------- `1i ❑ -•--------------•----•-•-------------------------------------------------- Distance to nearest lot line-----------------------------� ---�- ----------•-----•------------ .. t --------------------------------------------------- --------•----••----•--•------------------------------------ Remodeling and/or repairing (describe) __ "-_ i ------------------------•------------•-"---------------------------•----------- - ----••-----•----•----------------- € --------"-----------•------------•----•-------•------- -------------------------------- ---------------------------€•--------- =- ••------- -------•---------------------•----------••------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the.work will be done in accordance with San Joaquin ounty ordinances, Stat ws, and rul and regulations of the San Joaquin Local Health District. (Signed) �! ----------- -------- -------- --------------------- _______ ---__.Owner and/or Contractor] (Tifile]. By:------------- - [Plot plan, showing s'�e of lot, location of system in relation to wells, buildings, etc., can be placed on rev se side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ------------------------------- ,{{A DATE-- -------- !! � DATE --------- - ----------- REVIEWEDBY--------------------------------------------- --------------------------__A---------- ----------------------------- BUILDING PERMIT ISSUED-------- --------------------------------------------------------- ------------ -------------- DATE-----------------------------------------------------•-•----- Altera M . s and/or.reco 14en alions-------------y.-.. .�. - , i ,r--tj 'Irp 1' th ------- ---------- f ---.)-------------8---------- --- I ------- -------------- -- ---------- - -- ----- ------------------------------- - - ---------- ------- ;?o ---------------------------------------•- ----- 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 a Lodi, California Manteca, California Tracy, California E5-9- 2M 145446 A7WPna 12-54 ++•� --- ..