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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued -V Sb Ap.plica+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. �4. .2 - _,!:V1 -t ----------------------------------------I............ AN L -------- S --------- JOB ADDRESS AN LibcATION-1 _I I------- - --------- ----------- -- Phone,-'.--- ----------- ------- - --------- Owner's Narne--n- ----_------------ --I - I ----------------------------------------------------------------------------------------------- ................. Address Phone-----------------------_--------- ---------------------- --------- -- -------------- --------------- ---------------- Contractor's Name--------_-- -z - . Installation will serve: Residence Apartment House 0 Commercial 0 Trailer Court [:1 Motel 0 Other El Number of living units: Number of bedrooms _/__. Number of baths _/--- Lot size --`------------------------------------ Water ----------------------------------- Water Supply: Public system [:1 Community system El Private &Ir Depth to Water Tablez,6,2ft. Character of soil to a depth of 3 feet: Sand E] Gravel [I Sandy Loam 0 Clay Loam)K Clay E] Adobe C] Hardpan E) Previous Application Made: Yes El NX New Construction: Y!�v No E] TYPE OF INSTALLATION AND SPECIFICATIONS: aOO feet.) (No septic tank or cesspool permitted if public sewer is available within ria- ---------- Septic Tank: Distance from nearest well----11:r�-9-----Distance from foundation_,--� Tl- M 09 -- ------ 00__4�1 ------Capacity---P_------------- No. of compartments—'ef----- ------------- L Disposal 7 Field; Distance from neare f well dafion, well /._._-Distance Distance from foun ---------Distance to nearest lot line------14, ----------Width of ------------------ or ----- trench------,..----------------- Number I lines------- ----- _-Length of each line--- Type of filter material-,-�._ -----Depth of Filter material.--- -----_--Total length-------"-,-I ------------------ Seepage Pit: Distance to nearest well-,/ ------ �,�9---------Distance fcom founclation__-_&4�Z------ to nearest lot line---- ---- Number of pits---.../------ -------Lining material!'-`---------- ..Size: Diameter_7----------------Depth Cesspool: Distance from nearest well-----------------Distance from foundation._. --------------- Lining material-_..____._____._____-----___-_______. Size: - --------Depth--- -------- -----------------------------j_------Liquid Capacity----------------------------gals. Privy: Distance from nearest wellr------------------------------------------Distance from nearest building.____.._____.._____-._-._________-----. ❑ uilding----------------------------------------- nDistance to nearest lot 1ine---------- -------------------------------------------------------------------/ ----------------------------------------------------------- 5=2\ -P-modeligg nd/or repairing (describe) V/ ----------- ------------------------------------------------------------------- �/--------------------------------------------- -----------------------------------------/------I---------------------------------------------------------------- --------------------------------- ------------------------------------- -------------------- ........................ ...........Ir--- ------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State, laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..........�') ------------------ ------------------------------- --- -(Owner and/or Contractor) 4o----------- ------------------------------ --- (TRI By:_.. _.—TTRI -------------------- ------------- - --------------------------------- ---------------- - ----- fc., can be p ted reverse side). t, locat n relation to wells, buildings, e (Plot plan, showing size of, 0�. I ion of system i p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ---------- ---------- ------- -------------- ----------------------------- DATE----------------)----- --------- - 14-10 ------------------ DATE--------•----�----- ------- BY------------------------------------ ----------------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------ ---------------------------------------------------------------------- DATE---------------------------------------- ----------------- Alterationsand/or recommendations:.--- ------------------------------__----------------------------------------------------•-•-••---------------------------------------------------------- --------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ----------I---------------------------------------........---------------------------------------------------------------------------------------------------------I--------------------------------------------- ------------------------------ ------ --------------------------------------------------------------------------------- ----------------------------------------------------------------------------- - ------------------------ ------------------------------------------------;-------- ---------------------------------------------------------- ---------------------------------- ---- --------- FINAL INSPECTION BYe ------------------------- ------------- Date....------ ------- - - -------------- - 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 Er,-9-ZM 145446 A7WOOD 12-5.