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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 Ordii nce No. 549, JOB ADDRESS AND LOC ION.---- `3Ls (�. '4� _ (�---.... bgC1.2- ------------------------------ Owner's Name - -'4=—7 ------- !1 } ^+3 T __ - ---------- Phone Address-------------------------- =-_----------------- Contractor's Name-------•---------------------1----------&--,,--- ---------------------- •----------.. - -----• ------------ Phone Installation will serve: Residence YL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑� Number of living units: ---/-- Number of bedrooms _- - Number of baths /--- Lot size ._.____ __-_. __ _ -_ZR�_p .- Water Supply: Public system ❑ Community system ❑ Private* Depth to Water Table t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Aclobe_kr Hardpan ❑ Previous Application Made: Yes [] No ❑ New Construction: Yes ❑ No ❑ 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__ UDistance from foundation-l4----------Material __-------_ -- --- No. _ -- M of compartments----------�---------Size_-�_�_�X�iquid d --- epth ------ ----�- ------ � Capacity--------- Disposal Field: Distance from nearest wefi...J~�U....Distance from foundation---__-/_O-..-.Distance to nearest lot line-._-�^ Number of lines--------- .. --- ---Length of each line------ .Width of trench---------- �/�___- f Type of filter material- ►_______ ___ _Depfih of filter material..._..-12-----_---.Total length--_--.----_- -------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------_------------Distance to nearest lot line-------___-_----- W ❑ Number of pits----------------------Lining material---------------------.Size: Diameter----------------------Depth----------------------------_---- 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 ineRemodeling and/or repairing (describe):------- ' --•------- -- LL --------- ------------ ----------- -------------- ... -----. _.._. .�! -------- ------ --- ------- - ----- .��_ x - ------- ! , hereby c ify that I have prepared this application d that the work will a don(�in accordance with San Joaquin Cdr ty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)__----_--- ------------------ ----- a ---------------------------------(Owner and/or Contractor) --- -- ----- ----- --- -- ------- - ----------- --------------------------------------------------------------• - - - -- - - --------.(Title)- ------- ------------------------------------------------- (Plot plan, showing size of lot,Lcation of system inyr`elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------- �1--��-------------- -------------- ----- - DATE - ------------------ REVIEWED BY-- ----- DATE - ------- - ------------- �---------- ----------- ---------------------- • ------ --------------- ------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alterations and/or recommendations:.................... -.- -, --------------------------------------- -- -- -- ------ j�� ----------------- ---- -------------------- ------ ------- , ------------------ •--------------- ----- ---------------•-------------- ......... --------- --------------------- ----------------------------------------- - FINAL INSPECTION BY:----- i� -------------------------------- Date - 3 f I/ -- --f---• -- 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 145446 ATWvoo 12-54