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�,1n APPLICATION FOR SANITATION PERMIT Permit No. ... ----� ��y -- � (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here'sn described. This application is made in compliance with County jinanNo. 49.. ---- --JOB ADDRESS AND LOCATION-, . Jgo'r/- {' Owner's _ ---.-. Phone------------------------------------ Address... --------------------------•--------Address--- ___ - -----------_--- --------- --------------------------------- -------------------------------------- -------------- �Contractor's Name__. _ Phon r / . Installation will serve: Residence J4—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms 2_-- Number of baths .)----- Lot size -.S'6_____- -______________.___ Water Supply: Public system 94--C--ommunity system ❑ Private-0 Depth to Water Table/1-5- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe&Jdaxdpan ❑ Previous Application Made: Yes ❑ No 2�--New Construction: Yes 94.—ko ❑ 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 from foundation---f 10�._.__._Mat 7rial--_ 91— No. of compartments....... --------------Size_ --?(._4- ------Liquid depth--.L -- -------------Capacity_.. , ----.---- Disposal Field: Distance from nearest weld .._Distance from foundation--_- V..'__._.Distance to nearest lot line--- Number of I'snes____-___ ._.._ Length of each line._ _ .40--- ------------Width of trench._, -----_--_----.-_---.._. f, - ----.-Total length------I.2-2' `------------------- Type or filter material.__/..'_ _Depth of filter material _ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------.. N ❑ Number of pits----------------------Lining mater'sal--------....____------.Size: Diameter-----------............Depth----.---------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation ------------------ Lining material__._____.._.-..-----_-__-__-_--_-----. ❑ Size: Diameter----------------- --- - --------------Depth--------- ------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest yell-------------------------------------------------Distance from nearest building____-_-.-_.---_-.-_--____.----.--_--_. ❑ Distance to nearest lot line-------- -------------------------------------------------------------------------------------------•------------------------------- Remodelingand/or repairing (describel------------------ - ------------------ --------------•---------------...------------------------------------•------••---------------------•-------------- -------•-••-------•-----------------------------------------------------------------------------•--------------•----------------------------------------------------------------•--------------------------- - ------------------------- ---------------------------------------------------------------•------------------•-----------------------...-•--------------------..-.--------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5 ate I ws, and rules and regulat'ons of the San Joaquin Local Health District. c (Signed)... - - . ------- -- ---- ---- --- -------------------------------------------------------------- . ._ Contractor) ca B �s--J' -- ---- — -------- --------------------- -------- ------(Title}__. Y:.- (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-------- REVIEWED 8Y --- DATE---------- - --•--------------------------------------- BUILDING PERMIT ISSUED. DATE---.... Alterations and/or recommendations:---- •------------•--• -------------------••-•----------------•-----•-------- ------------------------------ ----------------------------------------------------------------•----------------------•...---------------------.-•--- ---------- •-------------------- ---------- --------------- -------------- ---. I- -.ter- FINAL INSPECTION BY:..- ----------_-------------3 '�----------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streot 300 West Oak Street 132 Sycamore Street 814 North 11C' Street Stockton, California Lodi, California Manteca, California Tracy, California e '"Rt�� E5-51-MM 145446 A-COD 13-54 - _..`..-._- ... .