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APPLICATION FOR SANITATION PERMIT PermitNo. ............ (Complete in Duplicate) Date Issued ---- 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 complia ce with County Ordinance No. 549. JOB ADDRESS AND C ]ON----- - ---- -------- --------------------------------- ............ ....... Owner s Name---•--- -------_------------ ---------- ------------------------------------- --------------------------------------- -- Phone-•------------------•--------------- ------ Address---- hone------------------------------------ Address..... -----------__ ------------------ ---------------------- -.•--.--- ------------------------ Contractor's Name--- ...;r-- ---------�_ �C7'------'"` ------ Phone----------------------------------- Installation will serve: Residence KL Apartment House [] Commercial [] Trailer Court E] Motel 0 Other [] Number of living units: _t- Number of bedrooms _Number of baths --)---- Lot size --------------------------- Water Supply: Public system 17"1 Community system El Private El Depth to Water Table ,/-a-1?ft. Character of soil to a depth of 3 feet: Sand E] Gravel [:1 Sandy Loam E] Clay Loam J-] Clay [& Adobe 0 Hardpan E] Previous Application Made: Yes E] No 9- New Construction: Yes R_ No Ej TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_,A/,#*%aDistance from foundation-/_0..........Material- - ---- - - ---- --9- -------------- No. of compartments-.-...?--------------- clepth__4_0 Q............Capacity-- D71.___--.-_---- -------- Disposal Field: Distance from nearest well Ak-r-t--Disf ance from foundation----/2_1-------Distance to nearest lot line---c fF_-�_. �_ Number ine--- Number of lines-----------/------ --------Length of each line---- -------------_Width of french----- -------------- Depth of filter mater al --- (?T h Type of filter material---/4- i - t,l lengt ------- -- --------------------- Seepage Pit: Distance to nearest welLA/_07-,e___.Distance from jbunclaLfion------4_11.Disfance o nearest lot line__.__46____. Number of pits.--.-/-------------Lining material. !f'-_A3444 Diameter__.. _ ......Depth----=f - ------------ r Cesspool: Distance from nearest well-----------------Distance from foundation.._.--.---._-_----. Lining material-_------.._---_----.----._-.._-_-____ ❑ aterial------------------------------------- 0 Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-------------------------gals. Privy: Distance from nearest well-------------------------------- ..... .........Distance from nearest building-_--_---_..---._-_----.-.--__-_-_--------. ❑ uilding------------------------------------------ El Distance to nearest lot line--------------------------- ------ -------------------------------------------------------------------------___---------------------- Remodeling and/or repairing (describe):-------- ----------- ----------------_--------------------------------------- --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------- ------------------------I--------------------- ---------------I---I.,---------------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� d rules and regulations of the San Joaquin Local Health District. (Signed -----;7 ------ -------- ------------------------ ----------(O ner and/or Contractor) By: . ----------- -------------(Title) ----------------- ----------------------- 1 (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--_----------------- -------------------------------------- DATE---.,(---------------------------------------------------- REVIEWED BY---------------------------------- DATE-----------71/--- - -- BUILDING PERMIT ISSUED------------ - ------------------------------------------------------------------ DATE------------------ ---------------------------------- Alterations and/or recommendations------............. - ---- -------------------------------------------------------------- --------------------- - ----- C------------------------------ ----------- - -V--------- -----r--- --------- ----------------------------------------------- ----------------------------------- --------- - ---- 6--r->---- ---- ------ ------------------- 2�-------- ............ ------------------------------- --------------------------------------------------- ---------------------------j----------------------------------------------------------------------- ------------ ----------------------------- ----------------------------------------- ------------ ----------------- --------------------------------------- ---------------- -------- --------------------- ------ -------------------------------------------- --------------------- ----------------- FINAL INSPECTION BY:. ... ----------------------- Date---- ---------------- 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 ES-e 145446 ATWC30D