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APPLICATION FOR SANITATION PERMIT Permit No. ._��:.�.�.� (Complete in Duplicate) Issued / This Permit Expires 1 Year From Date Issued Date .__..__/{.---___-- Application 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 Ordinance No. 549. JOB ADDRESS AND TION-- -W-l - ...... l�1- --- -- -- ---------- Owner's Name-___ C• ,�,r• ---------------------•-------------------- Address -- ----- - ............... •• -----------------------------------------••--•-------------------------•--•--•-----------------g-------------•- Contractor's Name-------------------- $ ±!Z/-------------------------------------•-------------------- Phone.�.-(A----/-lWJ*7 Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trail r rt ❑ Motel ❑ Other I�.1/ Number of living units: -------- Number of bedrooms -------- Number of baths___-_ of size .___-D_A-- __/_,�.5___________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .��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 ❑ No E4--f-HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,a Distance from nearest well_________________Distance from foundation--------------------Material-___._______._.______________-----_---____._____- No. of compartments-----------------------Size--------------------------------Liquid de th____--- _____Capacity 4444kid: Distance from nearest well- / , Distance from foundation---aZD---------Distance to nearest lot line -------- Number of lines--------- ________ ____ __ Length of each line_______15-01------------ of trench.___'p��-�-_--_-___----._- Type of filter material_�.e_4 __Depth of filter material------ length-------JO__--------- _______________ t: Distance to nearest well- t/ f ndation-__.�fl./-___.Distance to nearest lot line__. ___._ 411 Number of pits.____-_--------__Lining material_- / __Size: Dia met er-__.3 _._��_...___Depth----a-S_-_______________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__._..__-___-.-_----_.____________ •! ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals' Privy: Distance from nearest well----------------------------------_--------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line_ ------- ---------------------------------------------------------------•------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------ ------- ----------------------------------•-----•---•--- . --------------------------------- ----------------------------------------•---•------------------- ------•------•-------------------------------------------------------------------------------------------- I hereby cerf•fy that I have prepared this application and that the work will be done in accordance with San Joaqujn County ordinances, St to I w,,s,,�and rules and reg_ulatiions_of the San Joaquin Local Health District. (Signed)----------- -----------------------------_------- --- ----------- - - - Owner and/or Contractor) ----- - --- - - --- --- ---- ----- 8 �J ------(Title). -------------- ----- (Plot plan, showing size of lot, location of system in relation to well , undings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY / APPLICATION ACCEPTED BY-- � ...:....U, — ............. •----------- DATE-- f `� ' ��' ------------------ REVIEWEDBY-------------------------- ------ ----------- --------------------------------------•------------------------------------.--- DATE------------ ---------------------------------------•------- BUILDING PERMIT ISSUED------- -••---------------------------------------------------•--------------------------------------- DATE--------- -------------------------------------- Alterationsand/or recommendations:-----------------------------------------------------------------------------------------------------•------••---------------------------------• ------------- --- •---- -- ------------------- ---------------------------------------------------•-------•------------------------------------------------------------------------------------------------------------------------•-------------- ------------------------- FINAL INSPECTION BY:. 6- SAN JOAQUIN LOCAL HEALTH DISTRICT t30 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Rei sed 8-'59 F_P_Co.