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I APPLICATION FOR SANITATION PERMIT Permit No. .... ..- l (Complete in Duplicate) 4 Date Issued M Applicaa-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. JOB ADDRESS AND LOCATION--____-_- __ ------_ ------------ - Owner's Name---- .-- •- -• __-- `--- -- ,r% 1-----------------".------------- Phone___.___ Address......... _ :._. Contractor's Name___ �!Lr -- . Phone'_ . r wz Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel [-I Other ❑ Number of living _ # units: !�"___: Number of bedrooms _ -- Number of baths ---/-- Lot size __ _ ��: t✓ t -•----------- k]` _ Water Supply: Public system ❑ Community system F] Private;0„Depth to Water Table -do ft. y Character of soil to a depth of 3 fet: Sand ❑ Gravel ❑ Sand Loam Clay Loam Clay i Y ❑ Y ❑ y ❑ Adobe� Hardpan ❑�` Previous Application Made:- Yes ❑ No K. New Construction: YesNo E]r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] Of p est well &�---___Distance from foundation----/6-----------Material___ '. -_- No, of compartments----- --------- Size_..s�" _rk. Liquid depth_ - --.---------Capacity Plo, Septic an Distance from near Disposal Field: Distance from near r p est well_. __ -Distance from foundation--_.__ 6"...Distance to nearest lot line . Number of lines___.____ _-- ._ rr- "-Length of each line___----r-- _ Width of french----� Type of filter material__?-_____---K-Depth of filter material_._. ___ p /0-----------Total length _ -------------- -------- -----------•------------ . + $1 4 r Seepage Pit: Distance to nearest well._-_1_- -----___Distance from foundation_._�-�------.Distanc to nearest lot line__.�e- -_ �711 �[ Number of pits-k_./-----------_--Lining mate ria L_C{'1_. *+:*$ze: Diameter----. ---- Dept h-_------- --------------- Cesspool: DlsfanceDistance from nearest well-----------------Distance from foundation--------------------Lining material-----------------_ R ❑ Size: Diameter-I---------------- ------ ----------Depth--------------------------------- ------- Liquid Capacity ------9als. Privy: Distance from 'pearest well ..............______--_----" Distance from nearest building--------------------- ri ❑ Distance to nearest lot line-...... -------------------------• ----------- ---------------------------------------- -- Remodeling and/or repairing (describe)-------------------------------------- - ---•--------•----------•--- --------------- ------------------------------------------------- ----------------•-----------• - --•----- ------------------------•----------•-------•-----------------------------••---•-------------•--------------- --------------------------------------------------- --------- I hereby certif at I have prepared -ed this application and that the work will be done in accordance with San Joaquin County ordinances, St aws, nd rules and regulations of the San Joaquin Local Health District. (Signed) 1 - -- - --- --------- ----------- ------------(Owner and/or Contractor) -- - - -- - ------- - --- -- --- (Plot Ian, sows ----------------------------------(Title)---- i--- p ng size.of lot, location of system in relation-to wells, buildings, etc., can be placed on reverse side). L• FOR DEPARTMENT USE ONLY APPLICATION =q• r Y ' :: `- DATE_ REVIEWED BY----------- B- -- .... � � •-------- --------------------------------- ---------------------- --------•--------------- -- - -------- ------ DATE_----------- --------------------------------------------------------- UILDING PERMIT ISSUED______________•---------•-------- DATE.---------------- Alterations and/or recommendations----------- •-------------------------------------------------- ----- - -- ----- ------- ---------- ------------- ---------------- - --- - w �- --- -- ; ----------- ------- ------------------------------------ - I FINAL INSPECTION BY:--- ------ Date.-- = .� 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 KS-3 145445 ATw000 ) f