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APPLICATION FOR SANITATION PERMIT Permit No. .A- (_ T/____ (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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION ---- -"-_ •` ----- Owner's Name ----- -- - l ---------�rJ>/�oH--- Jam-----62 -------- --- ------------- ------ �� Address. 4�:� / gin _ ----------------- -------- ----- - -- ------------------- Contractor's Name_-- _- _- -- ----------- Phone._ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __Number of bedrooms ---/_ Number of baths --"7fLot size _._ �~ E]X-1- Water Supply: Public system Community system ❑ Private [_1 Depth to Water Table .5-Vft- Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Clay Loam E] Clay ❑ Adobe�ardpan E]Previous Application Made: Yes E] No New Construction: Yes ❑ No ❑ r: TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) pticLT Distance from nearest wall"-- -------------Distance from foundation--.----------------- - ------------- --- ------ No. of compartments------ ------- Size---_------------- ----- ----Liquid depth----- --- CapaclitY-------- ------------ D osel Id: 'Distance-from-nearest-well ,-� -- istance from-foundation__=_-:---,.::__-:Distance to-nearest.lot line----------------- .Number of lines--------------------- Length of each line--------- ---------- ------.Width of trench-=------ ---------- Type of filter material-__-- ----- ------(Depth of filter material__-.._-.--__.-- -_-.-Total length------ 4-1k - - - - r` � i ---------_ Seepag it: Distance to nearest wel14-t Distanc . rom f undation--------- + .1--.._..Distance to nearest lot lin _-_-._-J Number of pits-_'.-j.'-- `- Linin--rna.ferial-�__ -- Size: Diameter��___"__"Depth— L 1 g Cesspool: Distance from nearest well-------"--!------Distance from foundation; -----------.__-.Lining material--.--__--___- 4 c -----------------------. ❑ Size: Diameter .:----------- --------)----Depth---------------L-------------_2- ----------- ------Liquid Capacity ` ---gals. - --- Distance from nearest well---------- ------------------------------E _Distance from,nearest building 1- --------------------------------- Distance to nearest lot�aine--. -..--. :_-�— __ Remodeling and/or repairing,.(describe)'----------------"_ - •--- --------------------------- ------ ------------- -----------------------------------•-------------"---------•-•-----------•-------------------•-•---------------------------- --------1- --------------------- ---------- --------------------------------------------------------------------------------------------------------------------------------------------------- I here -certify hat I have prepare his applicat on and that the work will be done in accordance with San Joaquin County V' ordinances, a ws, an�l s and reg la ions of t e Joa n Loc ealth District. p a (Signed)------------ ------------------------------------------- --- -- ----------- - -- I- ------------------------- By:-----------------•------------------ - - - ----- -- ---- Title- \ antractor) r __ (Plot plan, showing size of lot, location of system in re at' n to wells, buildings, e ., can be paced on reverse side). ; FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------_---------------- --- - --- -------- - ------ DATE------- I - - - - ---------------------- ---------------------------------------------- VIEWED BY ------ ------=-- -------------------------- --------------------------------------- DATE-----------PERMIT ISSUED. ,; ----------•------------------------ ` -� DATE-----------•------ ----------------•- Alterations and/or recommendations-----------------------------V.-___ - ------------ ---- --- ---------------- - ;- - ; ------------------------------------•------------•------ FINAL INSPECTION BY:. - - . --------------- Date --` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Sfreet Stockton, California Lodi, California Manteca, California Tracy, California 14s446 e.rw000 iz- 4