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APPLICATION FOR SANITATION PERMIT Permit No. ___......._---1___-__J_ (Complete in Duplicate) Date Issued Applica}ion is hereby made to fhe 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 ANQ L CAT1 �___�__ - - -------- -`------•----------------•---- Owner's Name --------------- ---- ------------------------ Phone------------------------------------ Owner's �+. Address ---- ------- -- - ------------- ----------- Name r� --•---- �} /,['`� -- -------- e- Contractor's p House ❑ Cc ercial ❑ Trailer Court ❑ Motel Other ❑ ` r Installation will serve: Residence Apartment Number of living units: -------- Number of bedrooms -. Number of baths -------- Lot size ------ -.�_._ _ ------------------- Water Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to er Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ 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 faet.) — "y r Septic Tpnk- Distance from nearest well _. :.__Distance from foundation__-_--------------Material______-_---._.._-.---..-_-_--_--_.--------__-_-. �No. of compartments.------. r.Size--------•--------- -------------Liquid depth----------------- ------- Capacity-----------•------- , Disposal Field: Distance from near st well. _..__Distance from foundation_ .._.-__.Distance to nearest lot i�e___�__C:...... Number of lines___ -/.,.-Length of each line------- Width of french_____ _ r� r Type of filter materials! -.__._ --Depth of filter material-_- -------.-_. Total length___________ Seepage •f: Distance to nearest well_.C_. 4__._._.___-Distance f o fo clation___a_�_ _v___--..Distance to nearest lot line- _____ Number of pits_ ..___..Lining material__"Size: Diameter___".. _. ._*____Depth---- --3- _______,_ Cesspool: Distance from nearest well-----------------Distance from foundation----------------- Lining material--------------------._----------- [] Size: Diameter ---------------- -------------------Depth------- -------may--------------------------------Liquid Capacity-_-----•------- -gals.._ Privy: Distance from nearest well--------------------__.__...------------------ .-Distance from nearest building------------------------------------_----. ❑ Distance to nearest lot line--------- --------------- ----------- -- ------ - ----------------- -------------------------- -------------------- Remodeling ------------------------ 1 Remodeling and/or repairing (describe):------ -- �'_---- - _ .a .------------ ----------- ___ . \ -------------- ----- --------- -------41 --------- -------------- ------ -- ------------ ----- --- •-----------•- ------------------------------------- ----------------------------------------- --- -- ------ --- ----------------------------------•------------- --- I hereby certify that I have prepared this application a that the work will be done in accordance with San Joaquin County ordinances, State laws, nd rules and regulations of the S Joaquin Local Health District. 5 — Q ------- - -- __. ner an or Contractor)17 - --------------------------------------------- _(Signed)_ r - By:------- ...... ---•- - - --- ---------------- (T1tle} - ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-(""2 DATE_ ______________________-_.____.___-_--_-------------- ~ REVIEWEDBY----------------------------- - - ----- -- ------- -------- -------- ------------------------------------ QAT£ BUILDING PERMIT ISSUED-------_._-�------------------ -------- ----- ----------- DATE Qi(, Alterations and/or recommendations:------------- -- ------ --------------------------•---------------- ---------------'-------------•--•••--------------------- -----• i ----------------------------------------------•-----------------------------------------------------------------•----------------------------- ----------------I-----------------------------------------------------------------------------------------------------...---------------------•---------- ------------- -------------- --------------------------------- --------------------------------------------- ------------------------------------------------- - FINAL INSPECTION ----------- --------------------- -------------------- 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 • E5-9-2M 145446 ATWD�, X2-54♦ / �- (�