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APPLICATION i— A SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued (Application 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. JOB ADDRESS A OCATION------ ---- -- - --- ---- ----- --- --- --- - -- _1F---- --- --------------- - Owner's Name___ - --- -- - --------- -------- ---- - --- --------- .. .... ---- hon Address ------ . . ...... - - ---------- ----- ------ --------- - ----- Contractor's Name--------- - - -- -- -------- - ----- -- --- -- --- [] Motel Phone- --- Installation will serve: Residence Apart nt House Commercial Trailer Court el Other ❑ Number of living units: -------- Number of bedrooms Number of baths Lot size ---Xvv__,O�, ... -------------------- Water Supply: Public system E] Community system E]- Private Depth to Water Table�®ft. Character of soil to a depth of 3 feet. Sand E] Gravel [] Sandy Loam Clay Loam ❑ Clay E] Adobe L] Hardpan Previous Application r plicafion Made: Yes E] N O/K New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) optic Tnk: Distance from nearest well___--------------Distance from foundation____.--____________ -- �g2 o A No. of compartments--------------------------Size------------------ :------------Liquid depth------------ -------------Capacity------ ---------- DisposalId: Distance from nearest well.._.._______...._Distance from foundation--- ---------------Distance to nearest lot line_________________ ,E� Number of lines----------------------------------Length of each line-----------___-------.-.Width of trench--.---.-_-------------.---------- ( /�'��" Type rench_------------------- ---------- Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------------------- S,epaq Pit. Distance tp pearest lot line- I? Seepaq Pit: Distance to nearest Distance from fo P C ---------- ;kc� Number of pits.--/---------------Lining material Size: Diameter-�_ _.,��&__'bepfh------_Z"�------------------- e—Cesspool: Distance from nearest well--------------_Distance from foundation--------------------Lining material_____-_._-__-_______.____._________-. ❑ aterial-------------------------------------- 1771 Size. Diameter------------------ --------!----------Depth------------------------------------- -------- ---Liquid Capacity-.-------------------------gals. Privy: Distance from nearest Well— --11--- ------------------------------Distance from nearest budding-,-------------------------------------- ❑ Distance to nearest lot line------------------------------------------------ ------------------- -- ----- ---- ------------------ - ------- - - ------------- le ing;V-n-Ei7Z!)repairing (descri Remod I 'be).,_ ------ ----- P -- - ---- 1��------------------------- ------- Zo ----------------------------------------------------------------------------------------------- --------------- -- ------------------------------------------- ;I---------------- --------------------------------------------------------------------------- -- ------------------*----------------------------------------------------- ----------------------------------- ------------------------------------ ;;__1--------work *----------------------------------------- --------------------------------------------- I hereby certify that I have prepared'this-appli at*(n Jh Xork will be done in accordance with San Joaquin County ate I d rules and egulations o the ap"dCha+ laws,a �c he S qui oval Health Dlsf7l f. (Signed)-- ----------:!/---------- --- -----------------------(Owner nd/or Contractor) le By:----- -------------------------------------------(Title-- --- -- -- - - --------------- 't p T (Plot plan, size lot, loca syste in relation to wells, buildings, etc., can be p a ed on reverse e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------- j - --- ---- -- ---------------------------------------- DATE----------- .i fir/ ---------------------- --- --- ... -------------------- -BY----------------------------- ---- ------------------- ------------ DATE__ --------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------------- DATE--------------------------------------------- Alterations and/or reCommenotions:.---__-'-..__..__. - - ---- -- ------- - or -------------------------- --- ---- --- it ------------- - --------6t-_ ------------- ------4� -------------------------------- ---------------------------- I----tall - -------- ----- - ---------------------------------------------I-------------------------------------------------- (11P ---------------------------- ..------------------------------------------------------------ ---------- ------------------------------------------------------------------------------------------------------------ ---------------------------------- --- --------I---------------------------------------------------------------------------------------------- ----------•------------------------------------------- '' FINAL -------------I--------------------------------------- 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 Lodi, California Manteca, California Tracy, California E5-9 145446 ATWCCD