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APPLICATION FOR SANITATION PERMIT Permit No. ----- (Complete in Duplicate} k Date Issued Applicaa-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 complian ae with C!unty Ordinance No. 549. - --------- � - JOB ADDRESS AND LOCATION----- ---- - - �- �'-- ----- -- ------ - 'r - ------ ---------- •----------._.._. Owner's Name--- --- ----- - ----- '✓ '.�J ' --,e_d�---- ----------- Phone------------------ Address-------------------------dT1 1-'- ��.41 ------ - -- -------------_ --------- ------------------------------•-•-------------------------------. Contractor's Name------------------------------ ----------------- Phone Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ._ Number of bedrooms Number of baths _0-- Lot size--------- _77.'A-119-----_______________ Water Supply: Public system'14-1*1E-ommunity system'❑ Private ❑ Depth to Water Table 4000'�ff. Character of soil to a depth-of 3 feet:S Sand Gravel ❑ Sandy Loam E] Clay Loam ❑ Clay E] Adobe B---/Hardpan M ❑ ++ Previous Application Made: Yes [INo New Construction: Yes ❑ No ❑ - * J TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public s war is available within 2d0 feet.) Septic T nk: Distance from nearest _ Distance from foundation__. ----.------Material----- A_�____�_._!__�__- ff �- No. of compartments__ ll_____ Liquid.de th_._._�_._-_---- ____Capacity___ Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line.___._........... ❑ Number of lines-----------------------------------Length of each line---------------------------._.Width of french------------------------------------ Type of filter material-------------------------Depth of'filter material----------------- -----Total length------------------------------------------W Seepage .it: Distance to neare�well___g_�'Dis anc from oundation....IP-__.___.Distance to nearest lot line...S_---------- - arNumber of pits- ---------- - --Lining material-- Size:..Diameter. _��-.-__-.Depth-- , �-- --------------____-� Cesspool: Distance fi-om nearest well-----------------Distance from foundation--------------------.Lining material______.______._____.__..____________ ze: DiametSi -------------- - - y Li uid Capacity. gals. El Privy: Distance from nearest well------------------------------------------1--_.-Distance from nearest building--------------------------------------- - ❑ Distance to nearest lot line-------=---------------------------------------------------- ---------------I------------------------------------------------------ Remodelingand/or-repairing (describe)------------------ ---------------------------------------------•-------------•----------------••-=-----•----------:------------------------------------- ----------------- ------•-•------------------- --------------------------------------------------------------------------------------------------�-- ------ 3 I hereby certify-fhat I have preparelulaflons this application and that the work will be done in accordance with San Joaquin County ordinances to laws, an rules.ar► o ' he San Joaquintocal Health District. (Signed) .. ---------- --------- ---- •- -- -------- ----- ------------------ r Contractor} Br---------------------------------------•...... ------------------------------------- ------ - ------------- ---- (Title)--- - - A -----� -------- --------------------- (Piot plan, showing size of lot, location of system in relation to ells, buildings, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-r = - ------ ----- --------------------------- --------------------------••--------------------------------------------- DATE-�---------------------- --- - ------------------------- J\ REVIEWED BY---------------------------- -- •----------------------- DATE----�------- I•---...---------------------=---•------- BUILDINGPERMIT ISSUED-------- ---- --------------------------------------------------------------------------------------- DATE-------V� -------------------------------- Alteratians and/or recommendations:----`'--------- � °---------- ----------j;;---- , ^� '� - � � efi - -" it- -' `- `&- ----------------------------------.---------------------------------------- ---- --------- ----- f------------------------------------------------------------------------------------- �— �- ..---••------------------------------------------------ _ ----- ---- --------- --" ..__-_-_____-__.__• ____________________ ____ _______________________________---------------------------_______________________________ _________________ ______________________________________________________________ ______________________ " FINAL INSPECTION BY:. - •------- ------ - Date------ f � ` ! f. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOO 12-54