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. ,� Nr APPLICATION FPR SANITATION PERMIT Permit No. 1 .V �! (Complete in Duplicate) r Date Issued 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. 1 JOB ADDRESS AND LO ATION'_______.__ --- --r s-" --- .' ------ v •ate - _ -' . �.- - .-.,c---------- .F Owner's Name------ --------------------- Phone--- Address-------- hone .Address-------- Contractor's Name___-------- ---- --- Phone r-- - ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other ❑ Number of living units: __ Number of bedrooms _„ Number of baths ____!___ Lot size ______ 'r Water Supply: Public system Community system F] Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay-p( Adobe ❑ Hardpan ❑ Previous Application Made: Yes) No ❑ New Construction: Yes ❑ No,* TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,4ank or cesspool permitted if public sewer is available within 200 feet. Ilk ) ' Se tic Tank: ofC�om artmI 4 P- L�'. .., ,. :. 'ta axes well ---Distance from foundation--------•---------.MatErial_____________________________--•-----------•---. 1, /� ents_ .. -------Size- --a ----__ -_-_Li Liquid depth -----Ca acit � P :F q P P Y Dispos'I Fie Distance from nearest wefi__F,�_ _______-Distance from foundation__ __Q_r_______Distance to nearest lot line--4r / Number of lines_____________ _______________-_Length of each.1ine_____ __-� Width o€ french--4,-. u ' x ----- - ------------- ' "> Type,of fifter material- -----Depth of filter materia___j__.f-__,_ -__ g . � __Total length- ---�-----_---- .._Seepage Pit:. Distance to nearest well-----------------__---Distance from foundation_._._,=________-__.Distance to nearest lot line___________.._,.. [ _Nu'mber of pits-----------------------Lining material-----------------------Size: Diameter----------------------.Depth--------------------------------- -.,Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining materia-------------------------------------- El ______ ____________-_--____. ❑ Size: Diameter--------------------------------------Depth--------------------------------------------------Liquid Capacity----------------------------gals. I Privy: .- Distance from nearest well-------------------11 ____ _______________________Distance from nearest bui€ding___ ----------------4--------- --__-_-- z_ '❑ Distance,fioinearest lof line____ --------------------------------------------- r R odelrng and/or repairing (describe):__ t -------- -------- --------- ---- - - i .r I.here y certty t at I have re red this ap licafiion and that the work will be done in accordance with San Joaquin County ordinances, Staf,r' ws, and r an regulations of the San Joa in Local Health District. k . (Srgned)...... 3' �,�` (Owner and/o7, ractor) Plot plan, sho in size of I , loca • sem inn�elafion t - ---------------------------------(Title ---- _ J' '�+'"� ---_--- { p g o wells, buildings, etc., can be p-a'c'ed on reverse side). ` FOR DEPARTMENT USE ONLY / ti APPLICATION ACCEPTED BY- --------------------------------- ------------- DATE-� REVIEWEDBY - ------- - - ------------------------------------------------ -------------------------- DATE----------------------------------------------:----- BUILDING PERMIT ISSUED------------- ---------•----------------------------------------- DATE--------------Y - --------------------- ------------------- ------------------------------------ ------ --------------------------------------------------------------------•------------------------ Alterations and/or recommendations: ---------------------------------------- ----------------"•------------ -------------------------- ------- -------------- -----:- ----------------------------------------------------------•--------------------------- 1 r FINAL INSPECTION BY �, -- /tis" Date / --------------------------- AN JOA¢U,iId OCAL HEALTH DISTRICT 130 South American Street 300eWest'Oak Street '`' 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California +' Manteca, California Tracy, California ES-9-2M 8-51 Revised W-2100 K.