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APPLICATION FOR SANITATION PERMIT Permit No. <br /> (Complete in Duplicate) Date Issued <br /> Aplica4-ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. <br /> This <br /> application is made in compliance with County Ordinance No. 4,49. <br /> JOB ADDRESS AND LOCATION--------_--D00s- --------------------------------------------------- •- <br /> , ------------- 1 ----71.1-4-T---------- <br /> Owner's Name--------------- ------W--------- C C ----------- <br /> ------------------------------------ ------- - - - ------------------------ Phone----------1-4? <br /> -- -------- ........... <br /> Address------------------------ K+_1-------B." ­-------------­-------------------------------------------------------------------------------- <br /> Contractor's Name-------------------( -)---•--------------------------------•------ --------------------------------------------------- Phone----------------------------------- <br /> Installation will serve: Residence � Apartment House L] Commercial F] Trailer Court L] Motel E3 Other E] <br /> Number of living units: /____-_ Number of bedrooms 3_._. Number of baths Lot size ----------------------- <br /> Water Supply: Public system Ej Community system [I Private`4g Depth to Water Table Ax. ft. <br /> Character of soil to a depth of 3 feet: Sand El Gravel F-1 Sandy Loam E-] Clay Loam ❑ Clay [] Adobe Hardpan L] <br /> Previous Application Made: Yes [_1 No� New Construction: Yex No Ej <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) <br /> Septic Tank:, Distance from nearest well.-:J-17 Distance from foundation----1_0------- -Material ---C-2yrL,14 <br /> No. of compartments------ <br /> ---------Liquid depth---------(p-------------Capacity... <br /> Disposal ;elcl: Distance from nearest well---SP-1....Disfance"from foundation----,/.O---------Distance to nearest lot line____,.�------- <br /> E90 Number of lines---._--- ------ Length of each line-------`7.0___. Width of french------.2 Al-l-f------------------ <br /> Type of filter materia Depth of filter rnaferial Total length---------- --------------- ---- <br /> 4,_f <br /> Distance to nearest well______________________Distance---------------Distance from foundation__-._-_---._-_ <br /> Seepage Pit: - isfance to nearest lot line----------------- <br /> El Number of pits----------------------Lining material...--------------------Size: Diameter------------------.----Depth-----------------.----------_---_ <br /> Cesspool: <br /> epth--------------------------------- <br /> Cesspool: Distance from nearest well-----------------Distance from foundafion.-------------------Lining material_-._.---.___-_---_-_._.--_-._-.____-- Q,. <br /> ❑ <br /> aterial------------------------------------- <br /> El Size: Diameter--------------------------------------Depth--------- ------------------------------------------Liquid Capacity---------------------------gals. <br /> gals. <br /> Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._---._.--._-.-___-_----_.._-_..__-_-_-_-. <br /> ❑ <br /> uilding-------------------------- --------------- <br /> 171 Distance to nearest lot line--------- --------7---------- ---------------------------------•-•---------•--------•------ ---------•----------------.----------------------- <br /> Remodeling <br /> ------------------------------------------------ <br /> Remodelingand/of repairing (describe):------1-------------------------------------- --•---....... --------------------------------------------------------------- -------------------------- <br /> ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br /> --- ----------- <br /> ---------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------- <br /> - <br /> ------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- <br /> 1. f. <br /> I hereby certify that I have prepared Al!aaltca ion and that the work will be done in accordance with San Joaquin County <br /> P 'r "' that <br /> ordinances. S a laws, and rules and ns f the San Joaquin Local Health District. <br /> ..... . ............. ----------------------------------------(Owner and/or Contractor) 1Z <br /> ---------- <br /> (Signed)-o'--i ------ -- ---------------------- - --------------------- <br /> "I <br /> By.. --------------------------------------------------------------------------------------------------------------(Tif le)---------------------------------------------------------------- <br /> [Plot plan, showing size of lot, location of system in relation to w6l[s, buildings, etc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY---- - -------- ---­----------------------------------------------------------- DATE------..______ <br /> -------- DATE---- <br /> ----------------------------- <br /> ------------- ---- ---- -------- -------------------------------------- _ <br /> REVIEWED BY--* <br /> --- ----------- <br /> BUILDING PERMIT ISSUED------------- ---------- --------- --------/----------------------- DATE..... ---- <br /> ----------Z------------ <br /> 4 e401f. .P/---------- <br /> -------------- -------------- <br /> ?--V---------- <br /> AlteraTiyon and/or recom:/mndatio s:-------. r— ------ - <br /> OV <br /> 4<f�-------- - a--,e .......... <br /> 2__ -------------------------------------------------------------------------------------- <br /> ------------ ---------- -------- <br /> --------------------------------------------------------------- ------•--------- ------------------------------------------------------------------------------------------------ <br /> I <br /> ------------------------------- ----------(------ --------------------------------------------------------- -------D--a--t--e--.---­--------------------- -/FINAL INSPECTION BY--------- - ---------------- ------------------------------------------------------------------------- <br /> - <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfraof <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br /> Es---J-2m 145446 A7WOSD 12-54 <br />