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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) S 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 o. 549. JOB ADDRESS AND LOCATION.. - r/ -��-------- -------------- --- --- --------------------..... Owner's Name------ -- --*• -----�-`---- -- ... .. --- ---------------------------- ---------------- --- ------------------ -------------I----------- Phone----------------------------------- ---------------Address1 -•----. ------- f--•-----�'-----•-------------------------- Contractor's Name__ � �.... Phon �-2 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living unitsl,: j___ Number of bedrooms !r--.- Number of baths -_/-- Lot size _ _ --.--.---------__-____--_ Water Supply::.,Public syste�p E] Community system ❑ Private eq--Bepth to Water Table _ _/Oft. Character of soil to a depth'!of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ Noew Construction: Yes TYPE OF INSTALLATION AND SPECIFICATIONS: } (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: -Distance ,from nearest Distance from foundation___ No. of com artments____-1-.r-----------Size A,- -.C7:_ Liquid depth_ -- _-._ Capacity... moi____------ I 0-Y--__.Distance to nearest lot line--_-- Disposal Field: Qistance�from nearest weik_��.a__-r.-Distance from-foundation_____�_ � r I � N Number of Imes------- .. �- - ------Length of each line--- d------------------Width of trench-- __ _�.-- ------------------- t nce.f:lter material___ Depth of filter material____. "�--_.Total length--- -- --------_____._._---_._� . Type of; ------------ ` line--.- Seepage - See a e Pit: Dis a to nearest well_ _--.-Distance m fou ation___. to nearest lot line__. ___n__._ . ' p) Number"of pits.----�--__-------Lining material_ Size: Diameter�.?..` .......Dept lt'4?.__�`>. Cesspool: Distance from nearest well----*------------Distance from foundation------------------- Lining .❑��4 material-------------------------------------- �wSize:.Di -'� -------Depth--- ----- ---------------- ------Liquid Capacity------------• - -------gals.ay l Privy: Distance from nearest well----------------------------- ------------------Distance from nearest building---------------------------__---- -----. ❑- Distancel to nearest lot line.-...---------------- ------- ---------------- - ---------------------•------------------------------------------------------------------------ / p Remodeling and/or re alrm' describe --- --------------- --- -------------------------------------------------- •-----•------------------:--------------•--•-----------...._._. .---------------------------------------------------------------- N -------------------------------------------•----------•------------------------------------------- -----------------------------------------•----- ----------- -------------------------- ----------------------------------------------------------------------------------- lication and that the work will be done in accordance with San Joaquin County I hereby certify that l have prepared this app ordinances, State laws; an ales and regulations of the San Joaquin Local Health District. (Signed)---- .. ------ ------------------ ----------- ------------"=-------------------------------------------------------4Owner and/or Contractor) Y• --- -- - ---- ------- - ----------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). p. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED.,BY--- -------------- ------- a---- ------------• -----------------•---------------- DATE--------- ------------------------------------------- REVIEWED BY 1A - BUILDING PERMIT I - � - _ ---- -------------------- DATE--------\ ---- - ----- ------ ----------------------------------------------- DATE--------------------- Alterations and/or recommendations:------------•---------•---------------------- -----------••------------ ------------ ---•---...- q ----------------------------------- -------- ----- --- -- -------------------------- -- - ..... -------------------------- • Q � ----------- ____________________________ i !1 ______________________ _ --------------------------------- ._____.._.._.___..___._._ _.. .._.__....___._-____.___.. ----------_-_-------- ._ FINAL INSPECTION BY.............. -----------• --------------- Date---- _1.. ' " 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 4 Ii —2M 145446 ATW Poo 12.54 -