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APPLICATION FOR SANITATION PERMIT ,7 [ Els Permit No. ._ _ _ I (Complete in Duplicate) _ Date Issued r Applica+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. 549 132,�� G 1,] # -JOB ADDRESS AND LOCATION-----------------�-----.--��--��------------------------ ----_-._-- -------- ---------- --- /�_f?.t / _ _ �5----------------------------------------- Owner's Name.----------•----•------ �� TPhone-----------------------•--------•--- Address - � t1� ------------------------------------- ----------•----------------------------------- Contractor's Name----------------------------------------- ! y------------------------------ -------------•---------...----------------------- Phone--••------------------------------- Installation will serve: Residence jj& Apartment House ❑ Commercial Trailer Court ❑ ,M�,otel 0 Other ❑ Number of living units: _.C_._ Number of bedrooms --�- r of baths .--I- Lot size ______A__�-�'�"�__._ ______--___ Water Supply: Public system Community system ❑�riva e ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe.0�, Hardpan ❑,�., Previous Application Made: Yes ❑ NoSa New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool pe;mitted if public sewer is available within 200-feet.) i I foundation-'-/ Septic Tank: Distance from nearest welLC�.Distance from foundation_____________ ______Material________-__-.- ______. " No, of com artments_.. . _.__Size---- _ --��=�---Liquid depth_ Capacity __-.__.CapacityyOQ_____. Disposal Field: Distance from nearest well... Distance from founciafion----- �__....Distance to nearest lot line____- Number of lines---------- ____ _Length of each line-----------6.0_. -------- Width of french---------� rfl..___________ Type of filter material--!;:; of filter material___.____f __._!_Total length______________'___�Z_Q________ 00 ,' 1. Seepage Pit: Distance to nearest well------------- from foundatio :_ _____..Distance to nearest lot line_____ r a Number of pits------ -------------Lining material= 1ir': Diameter----=__1--�-------._.Depth----- - --,-_----------_-_- Cesspool: Distance from nearest well_________________Distance from foundation__.._:- --,__.__..Lining material__ .__.__________._____f----______. ❑ Size: Diameter------------------ -------------------Depth-------------- ---------- _--------------------.-7.-Liquid Capacity------------------------------gals. ��•._.._Distancle"+from nearest buildin � --------------- Privy: Distance from nearest well------------=-"---.--------------•---�.=--- � g---------------------- ------• ❑ Distance to nearest lot line----- -----------= - ------------------------------------------------------------------------ ------------- I .. � Remodeling and/or repairing °------- --------- - - --------------------• - y [J 1 .aIS�• ,�{. h .sd.�-_1`_�I_" 4. f N" .. -- --- }-- •----` ••----------1'•------------------------------------------------------- '------ L ----------- --------------------------------------------- I _--- ----------- ________ -- ----------------------------------------------•--------=-------------------------------------- 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 +he San Joaquin Local Health District. (Signed)----- ].- -------------- --------------------'------------------.----------------- ------(Owner and/or Contractor) BY= Tale ------ ( � --------------------------------------------- ---------------- (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE bNLY r ; / I APPLICATION ACCEPTED BY---------- -_ -- -- �:�rsr DATE--------7, ,e "rb �'', , j REVIEWED BY DATE - ' BUILDING PERMIT ISSUiD6------------ DATE Alterations and/or rec menda+io :_\ _ --A •---- • ----- -------------•• -- ------- -- i AU ------ --- -- •--15-- _ -�- - --- ----- ----------------------------------------------------------- r � 2 FINAL INSPECTION BYC-.t. ---------- ; 1 1 r'- --- ------ - SA JOAQUIN LOCAL HEALTH DISTRICT t , 130 South American Street j 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 11 Lodi, California Manteca, California Tracy, California ES--9-2M 145446 ATW09O 12-54 - _