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- �} APPLICATION FOR SANITATION PERMIT Permit No. ----- ' (Complete in Duplicate) f Date Issued �:_ --- Applical-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 No. 549. JOBADDRESS AND CATION-----------W-------- �' ...... -- r ----------------- ---------------------------------------------=--------------------•-- r,� ................ Phone.-----------�----------------------- Owner's Name________ __-, '--•-- r �"� � Address.............. =�c'.__�`Gr '®''� "�--------- ------ ----- -- --- ;--•------------------•- Contractor's Name -�� 4 �_�/�� r �-4r1 Phone Installation will serve: Residence 'n"-Apartment House ❑ Commercial ❑ Trailer Court'❑ Motel ❑ Other ❑ ' Number of living units: j___ Number of bedrooms A Number of baths f-___ Lot size .�,j��-,�- �-�-- ------------ - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel F1Sandy Loam ElClay Loam ElClay ❑ Adobe ardpan L] a Previous Application Made: Yes ❑ No New Constructions Yes ❑ No Pg--' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3 Sept Tank: Distance from nearest well__.__-___..____-Distance from foundation--------_-----------Material______.______-__.__-.. ------------------- _-.. No. of compartments-------------------- ----Size------- -- ---Liquid depth--------- .........------Capacity----------------------- is ieldi Distance from nearest well ................Distance from foundation--------------------Distance to nearest lot line-__._______-____. i Width of firench C. 1 Number of lines_________________________ _______Length of each I Type of filter material----- ------------------Depth of ate al-___.---.----------- -Total length----------.-----'i------------------__---- + se Seepage Pit: Distance to nearest well_. --Distan e from fo n !on____ _f-__ DisWnce to nearest lot line_-�_�__ Linin mater Ii.6._._._ - -�� De tn____ -__- Ic Number of pits... 9 ize: Diameter - p � - -- I Cesspool: Distance from nearest well_________________Dista from undation----_..._-.-__.._--Lining material------------------------------------- ElSize: Diameter.`-- ------------------- --------Deoth----------------------------------------- --------- Liquid Capacity gals. t --------------------Distance from nearest building . Privy: � Distance from nearest well-- ------_---�--- -..._ ----- ---------,.-----•--•---------------- ❑ Distance,to.neaarest lot line---------------_._.._--- wp tf ------------------------------------------'-------- Remodeling and/or repairing (describe):----------- - - -- =0 ------------------•- --- _ -------- Remodeling ------------- ----------------------- --------- -- -----------------------------•-------------------------------- -----------------------------------------------•---------------------------------------------------=---------- I---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe _, aan_d_ rules and regulations of the San Joaquin Local Health District. � 4L - Owner and'or Contractor Si red/ -------------- By:--• `fit/ -- [ J By:-�------ ----I---------4x --------------------- ------------------•---------------------------------- [Plot plan, show' size of lot, locationf system in relation to wells, buildings, etc., can be placed on reverse side]: o. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------------- ---- ---- a ----------------------------------- DATE l - REVIEWED BY------------------------- - DATE---------•---. - BUILDING PERMIT ISSUED----------- ------------------------ DATE. Alterations and/or recommendations:----_-------_..__.._ - ••--- ----- " ------------------------------ ------ rr -- ------ ------------------•--------------- --------•- --------------- -- -----------•------------ �:_-�----- --------------------'--------------- ------------- ------ - ---------------------------------- - ---------------- ----------------------------- -----.--. { ---------- --.•-------------------------------------------------- ------------------- - FINAL INSPECTION BY------ --------------�----------------- - --------- Date - - '---•--------------------------------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 1 300 West Oak Street 132 Sycamore Street 814 North ';'G" Street Stockton, California Lodi, California"., Manteca, California Tracy, California ES-9 145446 4.TWCDa