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APPLICATION FOR SANITATION PERMIT " Permit No. . (Complete in Duplicate) /01 Date Issued ---/-----_-- �'r ` Applica-ion is.hereby made to the San Joaquin Local Health District for a permit to construct and instgll the work herein described --'-+ This application is made in compliance with County Ordinance No. 549, -JOB ADDRESS AND LOC TION_._ r _- , ori Owner's Name... ..... Phone--- Address.--...... Contractor's Name-- ---- Phone----.. •----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: ._--- Number of bedrooms � -..�_. Number of baths�� Lot size Water Supply: Publics stem 'e PP Y� Y �" Community system ❑ Private ❑ Depth to Water Table ��_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ x--41 Previous Application Made: Yes ❑ No A`- New Construction: Yes [! �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) W k Septic Tank: Distance from nearest well_AjM!�:�Distance from foundation-_tl�--.-.-._.MatenaL Q k ` � No- of compartments,_-.4._ depth... Ca pa ! 10 , E- - P Y Disposal Field: Distance from neares well�"_?__O�Distance from foundationF/,�__.__,....Distance to nearest lot line.__--'' -_--.. [ " umYp ber of lines----- Length of each lineP � ,g'-_ a 'Width of trench-.-., j ��----------------- - --------- - T e of filter material-_1.4-- _ �pepth of filter material---_Af,--- ---_-Total length.---/ - Seepage Pit: Distance to nearest well_---__.--------------Distance from foundation--------... _.--._.Distance to nearest lot line----------------- Number of pits. mmm Lining material ---Size: Diameter----- Depth----- esspool: Distance from nearest well-----._-.-----..-Distance from foundation--------------------Lining material--..- { ❑ Size. Diameter---------- - Depth------------------------------ ----------------- ---Liquid Capacity, gals. Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building. ❑ Distance to nearest-lot line.-._--------- ------ - --- Remodeling and/or repairing (describe)__--- C_ describe) ---------- ------ -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County,- ordinances, State laws, and rules and regulations of fhe San Joaquin Local Health District. J J F (Signed)--------_-- OfAGnQr4�artcor Contractor) t BY�---••-------••-----•--•---------------------••- =-'----�-'---'�-��--��-- --------`-•- --------------- -- -- --(Title)---��---�l-�'s9�'".- .----- ---�--- ` (Plot plan, showing Size of lot, locat'o system in relation to wells, buildings, etc., can be laced on never side). e) FOR DEPARTMENT USE ONLY ---------------------- APPLICATION ACCEPTED BY--- = DATE - ------------------------------- REVIEWED 13Y----------- DATE------- ----- -------- ------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------- DATE---------------- - Alterations and/or recommendations:.----- 1=_#,• .• 1. Imo_- . ' �� k -----------------------------�.--..---__......-._-.--..--_-- ------ -----------.- FINAL INSPECTION BY:.------ l--° ------- Date_....----- SAN ---SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-4 145446 ATW0110