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..mow 'APPLICATION FOR SANITATION PERMIT Permit- No. ------ ---------_!), ' `(Complete in Duplicate}, Date Issued -_-.. ...... Applica-lion is hereby made to-the San Joaquin Local Health District for a permit to construct and install fihe work herein described: ` This application is made in compliance with County Orclinancg No. 549. .JOB ADDRESS A ATl -_�� - -------- -- ---------------------- Owner's Name ,;. -------------- ----- Phone-------- -- Address------- --------------- Contractor's Name--------------- - - - - --------- ---------------------------------------- ---------------- Phone—,7---`-- -- " 'y Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_-- Number of bedrooms ¢Z Number of baths----- Lot size - _ ,//1 ________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water TablQ'-- ft. Character of soil to a depth of 3 feet: .Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑" . Previous Application Made: Yes ❑ Nom` New Construction: Yes No E]M• / �# f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) it Septic Tank: Distance from nearest weiI__ve.40_—__Disfance from foundation-- .-._---.Materia No, of compartments_. - .----------Size ,/_'_Liquid depth__.. . _!...Capacity-,,7Q Disposal Fe D'Distance from nearest well---- ---------,Distance from foundation--------------------Distance to nearest lot line--------- : Number of lines---•-------------------- ------Length of each Fine------------------------------Width of trench-=----'------------'--____-- Type of filter material---'-'-------------------Depth of filter material----------------------Total length----------------------•------------------- S i Seepage if: Distance to nearest well --._----Distance fr rr fo ndation_ &1---+--_-- Distance to nearest lot iine____4r7 ---_ -1 Number of pits----t--------------Lining maferialr ---Size: Diameter-.?----------------Depth_ ?s Cesspool: Distance from nearest well-----------------Distance from foundation-----_------------- Lining material------_-.----.-.-----_------__-i--.-- '' ❑ 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 ------------------------•-------------••--------------------•--- -------------- I hereby certify that I have prepared this application and that the work will.be done in accordance with San Joaquin County ordinances, laws,,pd rules and-r gulations of the San Joaquin Local Health District. (Signed) --'� - -- ------------- - -------- --------------------- ,,,-[Owner amid/or ontractor) By: ..... ---------- ---------------- ------------------------------------- ------(Title (Piot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be Pl on reverse I e). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------- ------------- DATE' REVIEWED BY ii- - '-' - - DATE- � - i------------------------------------------------------------ --------------- BUILDING PERMIT ISSUED----------- _- ------------------------- -------------------------------------------------------- DATE_ --- Alt r ions and/or recommendation : = ----- ? + -- a= , .- ---- - - - _-- �° ------------- -------------•--- ------------------------- ----------- � r ------------------- • --- --- -- - -------- ------------ -- - - ----------==-•----------------------------- ----- ----- ----- f� f --- -' --'------------ ------------ ��yy � 7 --�s' FINAL INSPECTION BY: -------------- ------------ Date-'--- ' r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California a E5-9^2M 145446 ATWaOD 12-54