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APPLICATION FOR SANITATION PERMIT Permit No. a-b------_-- �, (Complete in Duplicate) Date Issued --t1i21A Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hgrein.described ' This application is made in compliant with County Ordinance No. 549. S JOB ADDRESS A OCATIO ... " -- ------ + f 1 ' Owner's Name - - - -•------ --------------- -------------------- ----- ---------------- Phone-----------•------- Address----------------k = .. -- ------------------------ Contractor's 1ti ------------------------------------•-••------------------------------------------ Contractor's Name----- -------------- --- - - ---------------------------------- -------------------------------------------- Phone ---•---•-------�---------------- Installation will serve: Residence Apartment House E] Commercial E-] Trailer Trailer Court of l he Number of living units: _-'---- Number of bedrooms ---�-._ Nur of baths -_I__-_ Lot size _--_--- -Q-.xe-ZO ----------------------- Water Supply: Public system ❑ Community system ❑ Private Deptht Water Table -------- ft. Character of soil to a depth of 3 feet: San Gravel E] Sandy Loam Clay Loam El Clay El Adobe ❑ Hardpan ❑ Previous Application Made: Yes E❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ;c sewer is available within 200 fee ) Septic nk: Distance from nearest weI4� c fr fou dation-b-L " , Mater' I -- - - ----- 1 No. of compartments ----.-*Size _ ,5�1� X - � - - iquid dp��p�t,h��,,,��// Capacity---- 0 7 ---- Dispos I Field: Distance from nearest well.. ._-._..----_Distance from foun ation__�i_0._-�.Distance to nearest lot 1i�}�.�r�--` P Number of lines----------- ------ Length of each lin e__------.-6-�_ __ _ Width of trench.--_ -_�rrt' Type of filter maferi -_-- �L�iaK p r �r De th of filter material---------- ----------Total length--------- - -------------------•-•_- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El 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 - ---- Remopleling!'and/or re airi-o—(dostribe) ----------------------------- ---------------.-...----------------•---------------------------------------••-------- -- - ------------------------------------------------------------------------•---------------------------•.------------------------------------------ ----------------------------------------------- ------------ ----------------------------------------------------------------------------------•------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District, --------------:------------------------------------------------------------- -------(Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (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 BY ------ DATE--�-------------------------------------------------- BUILDING PERMIT ISSUED---------------- --- -- -----------------------------------------------•------------------------ DATE---- Alterations and/or recommendations:_ ------------- ------ ------ ------------------------------------------ ---•---•---------------------------•--------- ---------------------------- ------------------------ --------------------------------------------------- •------------•-----------------------.---------------••---------- ------------------------------------------- ---------•---•-------------------- ---------------•---•-•-- -- -------------------------------------------------- ---------------------------------- -•------------------------ ------------------------------------------------------------------------------•----- ----------------------------------------------------------------------------------------------------------------------------------------- c-� �r FINAL INSPECTION BY:---- - -- ------IJO ----------------- Date---- �X {--- SANQUIN 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 ES-9-2M 145446 ATWOOO 12-54 .