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Ld pram, f ` (f�� APPLICATION FOR SANITATION PERMIT Permit No. ... _44-... (Complete in Duplicate) pate Issued . I!-z/�G �. 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. 11 It'll r rr JOB ADDRESS AND LO ATION _ f---------•-•------ �---------------------=------------------------------------------ Owner's Name - --- Phone---------------------- Owner's - Addressa -----••---•----- -------------------------•-----------------------.---------•--•--------------------- - Contractor's Name-----!.... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..I- Number of bedrooms _�� ,Number of baths .�-_ Lot size ------------------------------------------------------ Water _-._- ..--.:.Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tablel0....5- ft:• _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam.❑ Clay E❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction': Yes ❑ No ❑ 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--------------------Material __------- �o.-of compartments------------- ------------Size---------------------=----------Liquid deh.--------------<---------Capacity Disposal Field: D•stance from nearest well-----------------Distance from foundation....--- ._..:....-.Distance to nearest lot line---------..------ ❑ -144 oer of lines------------------------.-----------Length of each line------------------------. _--Widfh of french---------------------------- Type --------Depth of filter material.............. _-Total length--_----------------------_---------------- 's -------, - T e of filter material................. ..,, , , �. i Seep i istance to nearest well__,Jt.�,Oi-t .Distance from foundation. .__.......Distance to nearest lot line----/0----... Number of pits-------- ----------- Lining maferial--J?O-C,,<.t k` amefer------r - Dept k-4;. 7-------------------- 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-----_-._.....---..__..-------F.--_------ El —Distance to nearest lot line---------i------------ -------------- ---------------------•-------- Remodeling and/or repairing describe)-:.-..-- --------------------------------------------------------------------. -' �. -------------1.1.1.1---------------------- -- --- • - ------ I hereby certify-* I have prepared this application and +hat the work will be done in accordance with Sari Joaquin County • a ordinances, State 9 and rules and regulations of the San Joaquin Local Health District. (Signe ti----- �/-- -- ---- ----...(Owner and/or Contractor) " By:- ; # -:ill.. -------------------(Title)... (Piot plan, showing size of to#, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------ ------- ----------- -- --------- ------ DATE.... REVIEWEDBY...------- - •---•------------- ------- ----- ------- ------------------------------------------ DATE- BUILDING PERMIT ISSUED---------------------------- --------------------------- DATE.... ---- -----1111-- ------•--1111-- Al#era#ions and/or iecommenda#ions:------------------ --- -- ------------------------------------••-• - ------` �- ------------••-•-------- ........................................................................I-- C`f{{--l- --1111.__.-.._.....- .-1111.............:�.J 1111-._.._1111_. _ - ---------- --------------- - - ---- . ______ :------------___--.______------ -- 1111- .0- = --- ----.---- -1��-- ------------------- ---- 1111 - ----------------1111-. ---------------------1111-1111.- -•---------------•------------------•----------- . FINAL INSPECTION BY:.-- -- -------�-------1111.--•-1-------------u- •` `_ Date----1111--"'--1111-1111-- - . 1111 --`�-- ------•---------•1111-1.111. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D Wast Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5—.5 145446 ATWppn