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APPLICATION FOR SANITATION PERMIT Permit No. ...L_ ____________ Com lete in Du t I lica P P� e) � Date Issued Application 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 ith County Ordinance No. 549. 'L JOB ADDRESS AN LO TION. x , �-- ;+ Am--ll_��__%. ---------- f wnis Name-------- ------------------------------------- (/ Phone Addressj-�-- 9 *r---1- -----------�'!°--�+/��`= ------------------------------------------------------------------------------------•--- Contractor's Name------------- - - �r------------------------------------------ -------�-- --------------- ----------------- Phone i Installation will serve: ResidenCeL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __---- Number of bedrooms _-__--- umber of baths A---_ Lot size _-h9_0----_ _0------------------------- Water Supply: Public system ❑ Community system ❑ Private x Depth to Water Table ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes El , No �, ,New Construction: Yes ' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer isoavailable within 200 feet.) ; Septic Tank: Distance from nearest well_.. �-___-.-- istanc rcopfobur; dation-----[0------Materi I----- 'f -- No. of compartments Size_ `�_Liquid de th--------- p �--- q p. Disposal Field: Distance from nearest well-------- -----Distance from foundation_--- 445----_-__Distance to nearest lot line------ Number of lines----------I_------------------ Length of each line-----�12 ----------.Width of trench----22'b_//----------------- Type of filter material.—Z Depth of filter material-_-� -_rr.}}-. _- _- Total length---L�lo------------------ r Distance from ou�n aiorf_-_.. a _-_---.Distance to nearest t like 4,,�Seepage Pit: Distance to nearest well----------- 'f Number of pits---------------------�matenal_ - - - -- _ _-- _ - if :.DiamJJert�er----•--- --------------Depth---- -Q-- x----- -}--• 9, 02P Cesspool: Distance from near st well------- Distance from ound tion-- (.. _ material_,"CA__ _ - vt4-- Size�Diamete.r `- Qepth=_ /,_ ---- .Liquid_CapacitY 1 --•.gals. - ..r Privy: Distance from nearest well-------------------------------------------v_-Distance from nearest building____-_----------------_------------------. 11 Distance to nearest lot line-------- ----------------- --------------------- --------- -----------------------------•-------------------•---------- ---- Remodeling and/or repairing (describe):-----_ _ - -- _ , v-t "4r!' t •--•------ ---------------•--•------------------------•-------------------------------•---------------------- - ----------------- ----------------------------------------------------------------------------------------------- ---------------------------------- - ------------------•---------------------••-------------------------------------•------------------------------•--------------------------------•--------------------------------------- I hereby certify that) have prepared this application and t at t e work will be done in accordance with San Joaquin County ordinances, State laws, Anj�' ules and regulations o'f fhe as Jo a uin Lo6l Health District. (Signed) ----- ------------- ------ ----- ------ -------- ------------------------------------------------(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------------------ ------ 7- BY-- ---------------------- ------------------- ---- 1 ------ ------------ ----------------- DATE---------` e • -:- --------------------------------- BUILDINGPERMIT ISSUED------------------------------- -� ------------------------------ --------- DATE---------------------•--------------------------------------- Alterationsand/or recommendations------- --- ----------------------I-------------------------------------------------------------------------------------------------_ •••-------------------- -------------------------------------------------------•-------------- --------------------- -----------------------•------------------------------•--------------•-------------------------- ---•------------------------- ------------------------- ---------------------- ---------------------------- ---------------- ---------------------------------------------------------------- -------------------------------------------------------------- ----------------------------- - ------ ---------------------------------------- -- ---- ----------------------------------------------- -•- ---------•-------------------------------------------------------•- ----- FINAL INSPECTION BY---------------- ---- -------------- Date----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOJ D 12-54 -