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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) l D ! Date Issued .__-_--1 Applica+ion is 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. 549. t _ JOB ADDRESS AND L TION //rr�� --------------- --• ---------- --• ---•--------- --------•------•--- ---------------------- ---------- Owner's Name ,----•-. •---52,"40--------.- •----------------- ------ -------------- --- -- Phone..------..-..------ .............. Address----------- '' --Q--A--------- --- --- -`---- -------------------------------- Contractor's Name---------=------------------- ------•---------------------------- ---------------------------------------------- ••--"--•-----._._.. Phone----•---_------------........... . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel YY❑ O11th�fe//r ❑ Number of living units: __�----- Number of bedrooms -_AZ' Number of baths ________ Lot size ---101._11___�_! �7" •-- ---------------•-------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .$__-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic PECIFICATIONS-(Noseptic tank or cesspool permitted if public sewer is available within 200 feet.) --.Septic a 1 Distance from nearest well_________________Distance from foundation__._______.._____.Material__._____.__.__________._._______._ ct No. of compartments------------- --------�-/`Size--------------------------------Liquid depth---------- ---------------Capacity---------------------- Disposal Fiel Distance from nearest well.---4704Distance from foundatio __.__1. .__.Distance to nearest lot line___ .. Number of lines______._____--. ----__.._----. _Length of each line-------- _ -------le--Width of trench-,--, __________________ APit Type of filter material____..Depth of filter material__._.___._ -.-.-_.Total length_-__ ___________________________e age Distance to nearest well..__._._____--______Distance from foundation--------------------Distance to nearest lot line_._-_-____-.__.__ ❑ Number of pits----------------------Lining material-------------=---------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest wek3-----------------Distance from foundation--------------------Lining material----------------------.____________-. Size: Diameter-----_-.------------------------------De th----------- - Li uiId Ca.pacit gals'- Privy: Distance from nearest well------------------------------------------------Distance from nearest building----------------------------------------- 171 - --[] Distance to nearest lot line--- - - ---- -------------------------------------------------------- -------------------- ..... ---------------------- A Remodeling and/or repairing (describe)---------------- ------------------- -------- ----------------------------------------------------------------• --- ----<_ ....- --••-----••---•---------------------•------------------•------------------------------------•----------------------------•--•----------------------------------------------------------------------•------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules andlregulations of the Sdr Joaquin Local Health District. Signed . _ -----------------------------------------------------(Owner and/or Contractor] --------6�. By:--------------------------------------------------------------------------------- ----- ---------------------•---------------(Title)---------------------------------------------------------------- (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 ACCEPTED BY g-� DATE--------------------- "7 REVIEWEDBY --- -- f_ � DATE--------------------- ' 1_9-------------------------------------------- ----- ----- BUILDING PERMIT ISSUED------------•--------------------------------------- -------- DATE-------------------------------------------------- Alterations and/or recommendations:------- ------------ -- /--------------------------------------------------••-------- ------------------ ------------------•-------- ------------------- ------ --------------------------------------- -------------------•--------------------------------------------•---•--•-------------------------------------------------------- ---•---•------- -----------------------------------------------------------------------------------------------------•------------------------------------------------- -----•-------------------------------------------•--- -----------------------=---------•---------------•---•-----------•----- -------------------------------------------------------------------- --------------------------•--------------------------------------•-------- ------------------------------------ - ---- ------------ ... --------- --••-----•-- --------..._----------------------------------....._- -------- -----•---- ..........--------- FINAL INSPECTION BY:-.-. j----------------- Date----- l 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 AIWCUD 12-54