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u � � permit No. -.�•��-/-•.- a APPLICATION FOR SANITATION PERMIT / (Complete in Duplicate) Date Issued Applicakion 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 Or i ante Na. 549. JOB ADDRESS AND LOCATION_... -_ -- q-/��- ----••--- --------------------------------------------------------------------- JOB Name---------- ------------- Address-- --------- Phone----------------------------------- F /11�.JJ1�' ------------------------------------------- Address- Contractor`s Name----------- -- Phone----------------------••----• Installation will serve: Residence Apartment House ❑ Commercial ❑' Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units: ___ ____ umber of bedrooms --- of baths --- Lot Lo+ size __._-- -Ed - --f ----------------•- `°` *"' Depth to Water Table ___-._._ ft. Water Supply: Public system Community system El Private ❑ e p Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El Clay Loam Clax Adobe Hardpan ❑ r Previous Application Made: Yes E] NoA New Construction Yes Yes ❑ NoA 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------ ----------Distance from foundation__-_-___.-_-_.._-_.Materia--.__-._-.--.--__---.__---.------__-_-_-_..__` t ► No. of compartments ---Size---------------------------- Liquid depth--------------- - --------Capacity rr��^ ._- field: Distance from nearest well_ ---Distance from foundation------0s;u-.� ...Distance to nearest lot line j Number of lines------------ ____.--Length of each line_`_----_ -0-- Width of trench.___ __ Type of filter material-__..- -.-Depth of filter material_.--..-_.--� _-Total len ---- ____________________.____.._ Seepage Pit: Distance to pits well---------------- Distance from foundation----.---------------Distance to nearest lot line _._-..______.___. O i - -- ❑ Number of its Lining material------- -- -- .Size: Diameter--------------- -------Depth----------------- Cesspool: Distance from nearest well-----------------Distance from foundation._---...__,--------..Lining material__.__ Size: Diameter----=------------------ ------Depth----- ---------------------- = Liquid Capacity gals. ❑ Die#ante from nearest building---------------------------------------- privy: Distance from nearest well..............;--_------ , ❑ Distance to nearest lot line------------ -- ---------------- -------------------------------------------------------- Remodeling and/or repairing (describe):----- - --- - --- -------------- I - - - ------------- - ----------------------•---------------- „ :•• t� E hereby certify that I have prepared this application and that the work will be done in accordance with San oaquln pun Local Health District. R g ------------------------------------------- (Sign --__ --_ -----._.._._ __:__.___.(Owner and/or Contractor) ` ordinances, State laws, and rules and r�ati� of the an Joaquin Si ned ' MTitle h (Plot plan. showing size of lot, location of system in relation +o wells, buildings, etc., can,be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICAT€ON ACCEPTED BY------- ------------ -------- �-- DATE REVIEWED BY ------- ------ -- --------------------------------- DATE---------- s . BUILDING PERMIT ISSUED----------------- ---------- - -- -- ------ -------- -------------------------- DATE--------- ----------- Alterations and/or recommendations:--------- --------- _ - - ------_ --------------- ---------------------------- 1 FINAL INSPECTION BY:. E--- -- -- Date.. ----0 =? -,5-< ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street, 132 Sycamore Street 814 North "C' Street Stockton, Celifornie Lodi, California Manteca, California Tracy, California F E5-9-2M 145446 ATWDDO ;2-s4