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APPLICATION FOR SANITATION PERMIT Permit No. -- 4- (Complete in Dupiicate) Date Issued r6. a7%_ � Ap lication 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. JOB ADDRESS AND LOCATIONSA:--- OR- Y- -- 1 _t/,e�� '�1�rk--------- Owner's �Name----------------•--------------- Address------------------------------ --------------- --------------------------------------•---- - Contractor's Name----------_------------------ ------ `---------------------------- Installation - ----------------------Installation will serve: Residence Qj% Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: ---/-- Number of bedrooms.___ Number of baths __/-__ Lot size V------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table •------- ft- d Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam El Clay Loam El Clay E] Adobe•� Hardpan ❑ Previous Application Made: Yes F1 No E] New Construction: Yes E] No ❑�,LLFPte/77 60/-7-1-A-Ply TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tic • Distance from nearest well-----------------Distance from foundation_____-------------Material_____-----__---------------------------------•` . A-1 No. of compartments--------------------- -- --Size--------------•---------------Liquid depth------- --------- -----CapautY----------------------- A-1 ---------- --------•� - Distance from foundation_----------Distance to nearest lot line..... isp(isal i Id: Distance from nearest weal_ ------ - e. �7 Number of lines................./........-------Length of each Iine___e ------- -��- Width oftrench._ ------------------ is =------�- Type of filter material____---rl i --Depth of filter material____ ----------Total length___________________ D Seepage Pit: Distance to nearest well______________-_--___Distance from foundation--------------------Distance to nearest lot line--------- __._._ • ------------ ❑ Number of pits----------------------Lining material------------------------Size: Diameter------_-------------_- Depth-- --------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material_---__-_-____---_________------_----_ ❑ De th--------------------------- ------------------------Liquid Capacity------------------ ---------9 Size: Diameter-------------------------------------- p .t Privy: Distance from nearest well ____- ------------------------------------------Distance from nearest building------------------------------------------ - Distance to nearest lot line----------------------------- -------------------------------- -------'-- ----------'- ------------- �) - NA Remodeling and/or repairing (describe]:---------------------------------------------------------- -----------------•------------------- ---------------------•------------ � ----------------- ------------------------------------ -----------------------•-------'--------••---------------------------------------------------------------------------------------------------------------------------- I hereby a ify that I have jed pared t 's application and that the work will be done in accordance with San Joaquin County ordinances, S laws an les regu.a 'ons of the San Joaquin cal Health District. ( Contractor) 5ined ------------------- (Title) M-�-1-Q-�- ----------- By----------------------------------------------------- - --------------- -- - ------ ---- �� - (Plot p plan, showing size of lot, location of system in rel ion to wells, bus, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ __-.----_-- ---- - '"-�-E - DATE---- _r! - -`-�--- --------------------------- DATE REVIEWEDBY------------------------------------------- BUILDING PERMIT ISSUED-------------------------- ---------------------------------- DATE - Alterations and/or recommendations----------------------- ----- - ---------------------------•---------------------- -- --- --------------------•--- ------------ -----------• ------ - ----------------------- - FINAL INSPECTION BY-------------- r ------•---------'------------------------- Date------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT l32 5 camore Street 814 North "C" Street 130 South American Street 300 West Oak Street Y - Stockton, California Lodi, California Manteca, California Tracy, California Pr—q-2M 10-52 Revised W-2100