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APPLICATION FOR SANITATION PERMIT Permit No. {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 mpple in comp' Ie with County Ordinance No. 549. ES.✓ �T JOB ADDRESS AN C TON------------ -- ------ Owner's Name- ---- -- --- --- Phone------- ------- ----------------- Address -�y..-------- ------------------------------- Contractor's Name...-_ __-4A ._ .------ • ---- Phon ---------------------------------- -------------------------- - Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court ElMofel ❑ Other I] Number of living units. /-_-_ Number of bedrooms _&-- Number of baths -_---- Lot size — ...x_j-(��" ,,, - ------------------ Wafer Supply: Public system 9 Community system E] Private,*Depth-to Water Table _ijii./ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe . Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes jZ_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_WI2z.--Distance from foundation....14_ ---- MateriaJ.� r :/�Li.� No, of compartments_... .----------Size__, >_L_tLiquid depth.___.-_--"-..,.Capacity-_-.- ........... Disposal Field: Distance from nearest well_/ d71QDistance from foundation___0:2Q..-...--.Distance to nearest lot line__f_ _;LL Number of lines--------/-.......C___��_-_------Length of each line -.I- 'Width of trench-..---_-�--��------- Type of filter materia __ l.- .;_- S-.rpepfh of filter material. .__ . .----- -Total length-----o��--------- -----------•-•-� Seepage Pit: Distance to nearest well_ [ �d �J�.iCY-Distance fr foun anon___ -Q__.. Dis_tance �o nearest lot line... __.-----____ [ Number of pifs...../--------------Lining material_-,_h�� Diameter.. Cesspool: Distance from nearest well-----------------Distance from foundation.._.__.......... Lining material___________________ ❑ Size: Diameter------------------------ -- ----------Depth---- ---------------------- --......------ ---- Liquid Capacity. --------------------------gals, Privy: Distance from nearest well_________________--------__-. ..........Distance from nearest build' ❑ 9 - ------ ------- Distance to nearest lot line_._.___--------------" Remodeling and/or repairing (describe)-------- --------------------------- -------------------------- 4 ----•----------•---- ---------------------------•----------------------------------------- ------- -- --- ------------ ------- ------ ------ } ----------------_-------------------------------------•-----------------•---••------------------ � ----------------------------------------------------•----------------------- •--------------•----------------------------------------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s, and rules and regulations of the San Joaquin Local Health District. (Signed) -- - --------- -----� --- wn By.--- -- •-- ------ - •-- -- ---- ----- ----- --- ------ �-- �:r an r Contract /o or) Tit ) - .................. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). k FOR DEPARTMENT USE ONLY APPLICATION ACCEPTI=b BY.._.____._............. .. DAT>= --------------- ------- REVIEWED BY---- ------------------- C� ---------- ... ........ . .......... .......... ..... ... ---- ------------- ------- ----------------------------------- DATE-_ - -. UILDING PERMIT ISSUED----------------- -------- DATE----. --.-------- terations and/or recommendations------- -- ------- - -- -........ -`� d - .. -b F _. --------- -------- ------------ --------- --"..._. ...... ------------ -------------- ---- FINAL INSPECTION BY:- -- ............... I--. - --------- -------- Dafie...-lam-------- -�- --�- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amaric-an street 300 West Oak Street 132 Sycamore street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 ATW000