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1 , APPLICATION FOR SANITATION PERMIT Permit No. .___��U__------- 41,+ (Complete in Duplicate) 1p ��/ Date Issued ----- --------��-- Applical-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_____Z j ♦ C, 5 , ` �"'---- + -------------•----- -----"- Owner's Name -- ------ -------- Phone S ._Addres #rye•► f "R r ------------------------- •------``-,-�_�,---------- ---------- Cont'ractor's Name--- ' -----------------------------•------------------------- -----------------------------------• --•--- Phoned-- -�. --Aj� Installation will serve: Residence &&"'Apartment House ❑ Commercial.(—] Trailer Court -❑ Motel ❑ Other ❑ Number of living units: _.-1_____.Number of bedrooms _2�__ Number of baths __E____ 'Lot size ._7 �. -12(? Water Supply: Public system-M/Community.system ❑ Private ❑ Depth to Water Table-AO-11ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ .Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 2 New Construction: Yes M"'No ❑ �- TYPE OF INSTALLATION AND SPECIFICATIONS: _ . (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticDistance-from _.. . an : Distance from nearest well_.___.._.__.._-_ foundation_;'_=___._______.Material___".i__ ___ _____________________________- No. of compartments--- --------------------- Size- -------------- -----Liquid depth.----------- -------------Capacity----------------------- Disposal Field: Distance from nearest well.................Distance from foundation_-____- -_.._......Distance to nearest lot line______-_-"_-..._. mac. Number of lines___• ------Length'of each line------------------------------Width of french---------""__-- -------------------- Type of filter material-_____ __________________Depth of filter material_-.....................Total length-"______-._________.___._._"""""f_--""_ See a e.Pit: -7 Distance to nearest well p g 'sQ,._.__.__Dist� from foundation__J�j_.______.__. Distance to nearest lot lin .` ---" A --- • Dumber of pits------(---------------Lining materia_ ai�F± -Size: Diameter____3Q__"...""__Depth__"_. _"""""-___- Cesspool: Distance from nearest well-------------------Distance from foundation------------- Lining material-------------------------------------- Q ❑ Size: Diameter___-" -------------- ------------------Depth- ---= =----------------------- - --------------Liquid Capacity-- gals. Privy: Distance from nearest well----_--------------------------------------------Distance from nearest buildin ❑ Distance to nearest }ot line--------.------------------ ----------- ----------•------------ s Remodeling and/or repairing (describe):___._..- .__ ._.. __ A-UTkA f,�_ Q_ _ ---------- ----------------------- ------"--------------•----------------------------- ----- ------------- cordance with San Joaquin Coun#y I hereby certify-thaf I have prepared this application and that the work will be done in ac _Z ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed------------ •------- ---�-c----------------------------------------------- - - -----------------------------------------------------------------------(Owner and/or Contractor) By=----.----------•..... �".'u '� jf ----•------------------------------------------ Title d,t-W.___ - (Plot plan, showing size lot, location of system in relation to wells, buildings, efc., can be placed on Av'erse si FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- REVIEWED DATE_ -------A-- ---- - --- ---- ------------------ ------------IEWED BY - ---------- - ------ - ------- -- ----------------------------- DATE----------------- BUILDING PERMIT ISSUED. - DATE Alterations an ecp mendatio -------------------------------- ---�- ----------•- ., -------------•--•---- ---------------------------------------------- -- --------- ----- --- _EZd --------••-•-------- ---------------------------------------------------------------- --------------------------------------- -------=-------- -----------•-----------------------•---•---------------------------------------------•- -------------------- FINAL -INSPECTION B �' Date _ l ----- - ----- 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 f5-4 145446 ATWOao - Y