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N Y APPLICATION FOR SANITATION PERMIT Permit No. 0------- (Complete in Duplicate) --,__._. __-. � Data Issued __- 4A�ppli'ca+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. application is made in compliance with County Ordinance No. 549. 39 -----•--------------------- ---------- --------------------------------------------------------------- JOB ADDRESS AND LOCATION-------- ----- Phone.-------- ---------- Owners Name--------------------- - - --•--------------------- ---- ------------------------:---------------------- ---------------- Address--------------------- ---------•-----Address----------------------- . Contractor's Name--------------------------------- cal-w:41 -------•---•------------------------------------ Phone------------------•-----•---•------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ----- Number of living units: J-_--/Nutmber of bedrooms -3-.. Number of baths -_ --- Lot size ----- ------- ••-1-- Water Su I Public system © Community system ❑ Private ❑. Depth to Water Table -------- ft. # PP y` y y Adobe �ard an i Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam /❑ Clay Loam ❑ Cla ❑ P ❑ Previous Application Made: Yes ❑ No New Construction: Yes ►❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic Tank or cesspool permi++ea if ublic sewer is available within 200 feet.)l�A A)istance from ounc tion-- -iL�----------.Material--------°--- - ----------T' SepticlTank: Distance from nearest well-s_ . _--Capacity_-- -_Qf .4--- �' No. of compartments-...---_- ---__-.._size _ Liquid depth_-..---_ --_-- Disposal' Field: Distance from nearest we ._ ..- - Distance from foundation- Distance to nearest lot kinet_ �' ®� Number of lines--------- ---- --Length of each line-----_----------------{------Width of trench.-------v---- y--------------- Type of filter materiblk— - -'? _`k'Pepth of filter material------ - ---------Total length---------LX_ ------------------- 1 r Seepage Pit: Distance to nearest well----.._----------_--Distance from foundation--------------------Distance to nearest lot line-----_.--------. o F1Number of pits--- ------Lining material-----------------------Size: Diameter----------------:-----.--Deptn--------------------------------- lu (AllCesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material----------------.----------------ads. ❑ Size: Diameter------------------------------------- Depth----------------------------------------------------Liquid Capacity-.--------------------------9 -----...._Distance from nearest building Privy: ------------------------------------------ Distance from nearest wel!_---.._------------------------ ----- ❑ Distance to nearest lot line----------------------------------- --------- •------• - --------------------------------------- t Remodeling and/dr repairing (describe):------------------------------------------------------------------------------------------------------------ - }. ------------------------------------------•-----------••--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, Stale ws, d rules and regul tions +ha San Jo in Local Health District. ------ wner an r Contract - ---- --- -- ---- (O d/° °C] (Signed)- ------------------ (Title) BY:----------------••--------• ------•----------•------------------------------- ---------------------------------- erse side]. (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on rev FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-5; ._--------------------- .............................. DATE ----------------------------- REVkEWEDBY --------------------------------------- - DATE----A' '--------------------•-------------------------- BUILDING PERMIT ISSUED------------------------------------------- DATE - Alterations and/or recommendations--------------------------------- --------------- -------- ------------------------------------------------------ ----------------------------•--------------------------- ✓ 3� S AlDate-.. -- -- ------ FINAL INSPECTION BY:.-----4. ------ - ----------- -------------------------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 132 Sycamore Street 814 North "C' Street 130 South American Street 300 West Oak Street Y Stockton, California Lodi, California Manteca, California Tracy, California M E5�9-2M 14 x46 ATWOO❑