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APPLICATION FOR SANITATION PERMIT Permit No. .. 3__��_.G (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. ` JOB ADDRESS AND CATION ------- = --- -------•-•------ ------- ------------------- ------------------- - .._ C�- LTJ Phoned---r ^_d_v�al Owner's Name ------ - - ------------I ��------- - -----------------• - ---•---------=-----•--------- ----- -------- Contractor's Name �---------------------------------------------- `------------------------------=------------------- Phone-;3/0-4... _a _ Installation will serve; Residence 0—Apartment House ❑ Commercial ❑ Trailer Court ❑ M/otell ❑ Other ❑ Number of living units: _�_. Number of bedrooms .-vZ Number of baths _/____ Lot size ______/_._C "'�__-__________________ Water-Supply: Public system ❑ Community system ❑ Private -15epth to Water Table Character of soil to a depth of 3 feet: • Sand ❑ Gravel ❑ Sandy Loam ❑' Clay Loam ❑ Clay ❑ Adobe 2--Nardpan ❑ Previous Application Made: Yes ❑ No [��lew Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: -. (No septic tank or cesspool permitted if public sewer is available within 240 feet.) e is Tank: Distance from nearest well--;..____._____Distance from foundation--------------------Material_-----.__.-_-________________________________ No. of compartments--------------------------Size--------------------------------Liquid depth.----------------------- Capacity------ ------.---------- Disposal Field: Distance from nearest we1L.. d_�_._Distance from foundation____ �_:�__....Distance to nearest lot line___ ______ Number of lines---Y__.1------------------------Length of each line_____ ...............Width of trench-------- _,4/_`�_______--__ Type of filter material_Se_ 4 ._Depth of filter material---------4_ ___.Total length------414___________________---.._.-- d ------- �d______-Distance to nearest lot line_._`___-__ See�pa,�ge `t: Distance to nearest well._ ____.._ Distance orri f undatian_._ L� Number of pits--- I------------Lining mate ria l.--�-----Size: Diameter---�-�-_��---._.Depth------a �-------------- Cesspool: Distance from nearest well----------------- from foundation-------_------------Lining material__.._______-_________---_____.___. ❑ Size: Diameter---- --------- ---------.Depth--------------------- ------ -------- ------------Liquid Capacity------------------ ------- gals. Privy: Distance from nearest well---------_-----------------------------------------Distance from nearest building------------------------------__--_-_____. ❑° Distance fo nearest lot line-------- -------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- ------------------------------------- w ...........--------------------------------------- 1 ` F -------------------- ------------- ---------------••-------------------------------------- -------------------------------------•-------------------••----------- -------------•------------------------------ •---------------------------------------,----•----- = I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State-1 ws, and rul and, lations of the San Joaquin Local Health District. {Signed]_... r ner and/or Contractor) a ---------------------------------------- By-----------------------------••----- (Ttle} (Plot plan, showing size of lot, ocation of system in relation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------: ,------- --- ------ ----- ------------------------------------------ ------------- DATE-----.1��------------------ - ------ ---------------- REVIEWEDBY-------------------------------------- f------.------- ----- --------------------------------------------------------------- DATE------ -- --------------------------------------._. BUILDING PERMIT ISSUED. s ----- ------------------------- ------=------------------------------ DATE--- ---/I --- Alterations and/or recommendations:----------------- __ ._ -�-- w --------- --- ---------•-•-- - ---•--- -••-•-------•---•- ----• -- ------- ----------------------------•------------------------•--------------- _ -- ----------------------- --- -- - -------------- -------------------------------------- ----------- ----------- ------------------ ------------------------------• -------------------------------- -------`----------------------•----------- 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 E 5u9 145446 ATw000