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APPLICATION FOR SANITATION PERMIT Permit No. ---- --`--- ------- (Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and in all the work herein described. This application is made in compliance with County Ordinance No. 549. ( . ,l� - i'� �_ ---- JOB ADDRESS AND LOCATION._± -------f �� i 1.,___1_W"1& 4 --------- hone.--------------------- ------------ )111 -- - ----•--------- -------- --- Owner s Name_............ •-'----- , � --•------------------------ •------------ •------ Address_..------ ; ± ...�... --------• -------------------------------- ------ -- ---------- --------- Phone----------------------------------- ------- --------------------------•------- Contractor s Name. ------- --•-74R -- - -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other -- ---- __. _._ umber of baths . I--- osize Number of living units: __.!"'Number of bedrooms " � --- - - Lt - - Water Supply: Public system ElCommunity system E] Private ADepth to Water Table l "_ ft. Character of soil +o a depth of 3 feet: Sand F1Gravel ❑ Sandy Loam El Clay Loam ❑ Clay ❑ Adobe A Hardpan F] Previous Application Made: Yes ❑ •No JV/ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ',�E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d ,Septic Tank: Distance from nearest well---= rt-'�.Distance from foundation-----�--------Material------------.""-------.--------------_----------- 'Af -9A;t.�- A No. of compartments-------------------------Size-------•----- Liquid depth - Capacity �r {J pisposal Field: Distance from nearest well___ C)- "Distance from foundation_..__.__��s- -"Distance to nearest lot line.-9-....._... dT. Number of lines-------- -------------- -Length of each line----.-- _ -- 1r-_. Width of trench------ - '------------------ /� Type of filter material---�`_r 'Depth of filter material�..___ _ .. ..Total length.______` ------------------------- Seepag�i Distance to nearest»Ρweli-- -------------_--Distance from foundation-_.____...__.._..-".Distance to nearest lot line_____..._________ t Size: Diameter De th---- ---------------------- ❑ Number of pits.---�-----------'-Lining material"_.------" p L I r Cesspool: -k •Distance from nearest well_----------------Distance from foundation--------------------Lining material------------------------------- els. .�.. . E] Size: Diameter----- -------------=--- - - ----ADe th ;; _: _-Liquid Capacity r _ g p _ �- _. � — L ` ------------ - ------Distance from neares# building------ --------------•--•----------- ---� Privy: Distance rom nearest well.'__.....________________. ❑ Distance to nearest lot line -----------------------------------------•---------•------------------- , � �ing and/or repairing (describe)- '---_Remodel _r------- ----- --- ----- --3--- � - - „ex u - + """__.______-"-"___-_"""""-_-..._"._____._____. - . ------------------ -------------------------------------- "__...____._- ._.__. _.___.______ ____..___ I hereby,certify that I have prepared this application and that the work wiii'be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. F, ------------------------ and/or d or(Owner an / r Contract ) (Signed)/--_.--- d�_•---. ------ ----------- ----•-------------------•---------- ----•----- ----- ------ �. .. (Title)--------------------------------------------------------------- By--------------------------------------------------- ----------•------------------------------------ ------------- (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--------- ---------`------------ - --------- ----------- ---------------------------------------- DATE_--- ---.Y - -------------------------- DATE ------------------------- REVIEWED 13Y DATE----------------------------- ----------- BUILDING PERMIT ISSUED "- �.. �-: -•- ------- 'v ------------------------- ---------------- Alterations and/or recommendations:------------------.._ ---------•------ _... ------------ ---------------- r __________________ --- --------- a ' `' --- ----- -----------------_-.""-.. •---------- -f - - -------------------------------- --------------------- ---- --------------------------------- ------ 2-4---X7_7---- ------------------------- FINAL INSPECTION BY-- ---- ------ --------••----------- --- --- bate.-------------------- " ' ,SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 614 North "C" Street 134 South American Street Trac California . Stockton, California Lodi, California Manteca, California Y. gs.-g 54-45 nTwooa -