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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 install the work herein described. This application is made in compliance with County Ordinance No. 549. h JOB ADDRESS AN OCAT ON___�__0 _.__ _ k&. ____ _ y ,1 /f p Owner's Name- -----• . ------. &Q�GW- 9----- �" ------------ Phone__A_�iC&Q-.e�it l Address-_(9_�;l0t ...... ---- -------------- Contractor's Name-----------------------------P ------ Installation --Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ,w Number of living units: ___.--- Number of bedrooms -------- Number of baths -------- Lot size _r--------_-_- ' Water -Supply: Public system �ommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: S;��New Gravel El Sandy Loam El Clay Loam ❑ Clay E] Adobe Hardpan E]Previous Application Made: Yes ❑ No Construction: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) !10Sepfic Distance from nearest well_________________Distance from foundation____._____-._--__---Material-__________.__ ___.__-_-______--________No. of compartments--- - - -- - -----------Size--------------------------------Liquid depth----------------- ------._Capacity---------- -----°sal Distance from nearest well__ Distance from foundation--------------------Distance to nearest lot line----------------- 66-1-1 Number oflines-----------------------------------Length of eachline-------------.-_------__---.-.Width of trenchType of filter material--------- ___Depth of filter material----.-__-_-__.._....__.Total length_______..____________________-__________._ / 1 � Seepag if- Distance to neares# well __ Distant from foundation__!_ ____.__.Dista`� to nearest lot iine�__-r3_--____- Number of its----------------------Linin material. .------...-- ------ , -3 De th___ p� g .Size: Diameter.__ _. p �.�------------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------...------------___________- ❑ Size: Diameter---------------------- ---------------Depth----------------------------- -- - ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------------____-Distance from nearest building.___-.-______.______________________._._-. ❑ Distance to nearest lot line---------_----- - -------- - ------ ---------------------------------------------------------------------------=--------------------------- Remodeling and/or repairing (describe)---------- ---------------------------- ------•---------------------------------•------------•--•---•-----•---------•-- ------------------------------ -_---------••----••-------------------------------------------•-----------------------------------------------------------••----•-•-------------------• ---------- ---------------------------•-------------•----------- ---------------�,k,Sfcer I h ify th t I have�ssepared this pplication and that the work will be done in accordance with San Joaquin County ordinanclaws, d rules nd regulatio s of the S Joaquin Local Health District. (Signed)---- C3 _ � ��------------------------- Contractor) By: {Title) wi-A), eF or (Plot plan, showing size of lot, location of system in rel ' n fo wells, buildi s, etc., can be pl ced on reverse side). FORVDEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- - - ------------------------••------------- DATE..---- REVIEWEDBY----------------------------------- - - - - ------------------------------------------ DATE-------�� BUILDING PERMIT ISSUED----- ------------- DATE------------------- =, - ---- - Alterations and/or recommendations:_-_______-.. -11-1 . --------------------------------------------------------_------------_---------_-------------------------------------------------------...--------...---------------------------------------------.--------------------------- ----------------------- ---_--._-��1 _____________________________________________________________..r__�.__-_____...._•_____.._..__.___..__.________-_________._____--.___--_-_.__.___.__...____._..__-______._..______.__.___..____-.--__.._____________--_____ _ FINAL INSPECTION BY---- ------------------------------------------------------------ Date. ------ ©- S '- S c r � 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 Er,-9-2M 745446 ATWAOD 12-54 -