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APPLICATION FOR SANITATION PERMIT Permit No. . ii (Complete in Duplicate) •••q/ -----/---_-- Date Issued Application is herety made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This$pplication is made in compliance with County Ordinan e No. 549. JOB. ADDRESS AND LO—CATION- . _- A/tor ' - Owner's NP e_� -_- ----------------------------------------------------- -------------- - - --- --------------------- - Phone Address____ __t.. _--_ - -- ---- ''---• ------- ------- ---------------------------•-------------------...--- il -- Phon Contractor's Name �7i� -- ---------- Contractor's will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel er ❑ 19 !_Number of liven units: - Number of bedrooms .-- _Number of baths ---2---Lot size ------------------------------------•- Water Supply: Public system'- El Community system ❑ Private A"°ePth to Water Table-oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E Adobear pan ❑ �l Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No u TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] S ti Tan1t Distance from nearest well-----------------Distance from foundation--------------------Material .-_----.._--_._.-.----..-..--------------------- No. of compartments--------------------------Size--------•-----------------------Liquid depth---------------- -------._Capacity----------------------- isposal Field: Distance from nearest well---_.,_.---. Distance from foundation-------.------------Distance to nearest lot line------ f Number of lines-----------------------------------Length of each line-----------------------:------Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material--------.---------.---Total length------------------------------------------ il �g "� _.___.Distance to nearest lot Seep ge Pit: Distance to nearest well r- --Distance rom foundation_.___.._ '! f 3�-' Number of P' ifs -. ---Linin mate ria l--�-_---Size:..Diameter- f ._-._:_____Depth.___ ----------:.------_� A 9 °' Ceiisspool: Distancejyfrom nearest well_-._._._..___._-Distance from foundation._.____.___.-------Lining material_____________________________________ ❑ Size: Diameter-------------------------------------Depth.--------------------------------------------------Liquid Capacity- -----------------------gals. Privy: Distance '4from nearest well..._._,_..--_----------------------------------Distance from nearest building___._.__________.____________.._.___---. ;❑ Distance,lto nearest lot line--- ----- ----- -----•-----------------•- ------ Remodeling and/or repairing (describe)------------------------------------ ----- ----------- -- •---�-------------•---------------•-------••-----------•-•-------------------------------•---- t -- II ---•--••-----------•--•---------------- --- -----------------------—1---------------------------- --•---------------•--••---------------------------------------- I hereby certify that I.liave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ...ate laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---- ----- ---- --------------------------------------- ------------------ (�od� Contractors sY= �; (Plot plan, sh6s ing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �i. OR DEPARTMENT USE ONLY REVIEWED BY BY-- ----- - - � APPLICATION ACCEPTED ------------ ---------- - ----- ------------------------ DA --- -- BU.ILDING PERMIT ISSUED----------------- ----- ------ DATE--� ----- ---------------------- Altera#ions and/or recommendations--------------- --------- ---------------------------••-------------- ----- --------------------------------------------------•--------------------- --- ----------- Il ---- --------- --------------- -=-- ..------ --- ----------------------------- --��- II iD ------------------- -------------------- ------------------------------- -----�--------------------------------------------------- ------------------------------ ------ -- FINAL INSPECTION BY:-��_/_ � �----- --------------- -•---- ---------- - -. Date--------------------------- 17- I I SAN JOAQUIN LOCAL HEALTH DISTRICT �\\ 130 South American Street, 300 Wes+ Oak Street 132 Sycamore Street ' 8!4 North "C" 5+roe+ Stockton, California Lodi, California Manteca, California Tracy, l li ES9-2M 145446 ATWOOO 12.54 lpp, J