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APPLICATION FOR SANITATION PERMIT Permit No. J.�__33" (Complete in Duplicate) Date Issued Application is hereb This y made to the San Joaquin Local Health District for a permit to construct-and install the work herein described. application is made in Compliance with County Ord'nan-e No. 549, i i JOB ADDRESS A OCAT4ON _- "( , 'L,) "" """ r ------ -i-------- --------------------------- ------------------ 54 -------- ----------•---------------- Owner's Name----- ----- - ---- ---- ---- Address-------------•- i-_ Phone__ ------- - ------------------ Contractor's Name_____ _. .v - -- --------------------------- Phone----- Installation will serve: J Residence ❑ Apartment House r ❑ &om�ferial Trailer Court � ' Motel ❑ O e ❑ Number of living units: _-.._ _ Number of bedrooms _'____-- Number of baths -_� Lot size -"_ Water Supply: Public's s�`feni: """Communit 's stem i PP Y' Y Y Y ❑k Private`�l Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand/' y {am Clay Loam ❑ Cla1 Gravel ❑ SandL Previous Application Made: Yes ❑ No ❑" ion New Construction: Y El Adobe 2 /Hardpan ❑ c : Yes L� No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i ublic WWer-is available ithin 200 feV �,�Septi ank: Distance from nearest•well!P ____ Disfanncp fromTfoundation-" _ ---------- --- .i l_ "� " No. of compartments___ T- ---Size_-- X- ?� Liquidlept}� ` ------------ ------ -------- Capacity---- a -{ Dispos Field: Distance from nearest we!. istance fromfoundationf_ _____ _" lata ce fio nearest lot lin -.""-_-"•-"" """ " 1 Number of lines------ � "-- --Length of each line---____-- -- Q � Type of filter materi Width of trench.-______1 - "- ' r ' epth of filter material---.----. � J*� - -r--_.Total length--------_ 1-61,41_____ i Seepage Pit: Distance to nearest well-._.------------------Distance from foundation__-_____- __ _ _._.__.Distance to nearest Cot line_._______-""__--" S ❑ Number of pits;_'-------------------Lining material------------ Size: Diameter Depth --- --------- Cesspool: Distance from nearest well________________ Distance from foundation__._._.------------Lining material El Sire: Diameter:----._____ ----------Depth---------------- ---------- ---- ----------Liquid Capacity---- Privy: Distance from nearest well ------------------------gals. rn ___"_.._.______-"-___rt"---_ -------------------Distance from nearest building_-_-------.- -------_- ❑ Distance to nearest lot line------------------------- _- - ------- --- ---- -. ------------------•----------- - ----------------------------------------- - Remodeling and/or repairing (describe):----------------------------------------- ---------- -- 1 t -----------------------------------------•----"------•---•--------------------------------------------------"--------------- ---------------------------------- ------------- C 4 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin ounty ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. , --------------------------------------------------- -------------------- ---------- ---------(Owner and/or Contractor) BY: ..fie_ ',t,=- ---------------(Title)-------------- (Plot plan, showing si�of lot,jlooccation of system relation to wells, buildings, efc., can be I ------------------------- paced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__ i ---------------------------- ------------------------------------•------------------- DATEr '. REVIEWED BY-------------------------- ----- --------- --------------------------------------------------------------------------------------------------- DATE__ BUILDING PERMIT ISSUED-----•------- - ----------------------•------------------------- - ---------------------------------------------_---- ---------------------------------- DATE---- . Alterations and/or recommendations:_'------------------"_"" O^ ------ ----------- ----------------------------- Y FINAL INSPECTION BY:......... " - -- -•------ 17 r SC 1 P ---- •----- Date-------- -ia / SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 Wes} Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4-21V 10-52 Revised W-2100