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APPLICATION FOR SANITATION PERMIT Permit No. - � ------• (Complete in Duplicate) Date Issued . Applica}ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein dead. This application is made in compliance with County, rdinanc o. 549. ' ._. -- ----------------------------- --- - JOB ADDRESS AND O�cATION....__._ _� �'E� , Owner's Name _- ------ Phone.---..-------- ------•--------- )----(! ----------------- -- ----------- ---- Contractor's Name----- •- ----------------- Phone----•------ - -- ---------------- --------------------------- Installation will serve: Residen ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Of Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ____6 --x---- ------ Water Supply: Publics stem ❑ Community system ❑ Private ��{{ Depth to Water Table SI ft. Y �'1 Character of soil to a depth of 3 feet: Sand ❑ Graver' Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑a No New Construction: Yes x No ❑ TYPE OF INSTALLATION AND SPECY ICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Q ---- Septic Tank: Distance from nearest weft_:-=L�_Q-_- Dista c from�f/oun anon____________________Mat r�al--._._.-____.__.__.___.___________.�'�. No. of compartments____ _----.-.----.-Siz - --X_- .�__Liquid dffepth_.._._ 'r..--_Capacity.. _. _© _1- ...Distance to nearest lot li e_..___�_ "' Dis oral Field: Distance from nearest well_1-.� ..._Distance from foundation__-__. E.. Number of lines---------3......---,--=--- --f�Length of each line_.__ _ _ `-- Width of trench---. .- r'---- ------------ Type of filter material---S_T� _ Depth of filter material- -. .. ..........Total length________ +�_.' "............. Seepage Pit: Distance to nearest well---- --------------Distance from foundation--------------------Distance to nearest lot line___,-______----. ❑ Number of pits____.................Lining material---------------------- ----- p --Size: Diameter------------- ---- Depth -- ------------• Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-- ----.---.__._.____-_--_.____---_. Size: Diameter -.-----�:----- pth Liquid Capacity als. Privy: h Distance from nearest well .____-------------------_.------------------.,Distance from nearest building-------------.-___.____-__--._._____-_--. ❑ Distance to nearest lot line__________________ Regodelin and/or r pairing (describe): . '�L�-.�/� = r'�'® -----•-----;?.g--- ' --------- ---- -------- -• -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancesJX aw , rules and regulations of the San JoaquALocal Health District. (Signed)---- 740r,------ --------- --------------------- and/or Contractor) BY: Title _ - - -- ---- ---------------------------------------- ------- ------{(Title) plan, -size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY-" APPLICATIONACCEPTED BY-------------------------------- - DATE--------------------------- -- ----------------------------- REVIEWED BY-------------------------------- DATE .> -----------------------------------------------------WSA BUILDINGPERMIT ISSUED------------- ---------------- ------ -------------------- --- DATE-------------------- --------------- ---------- Alterations and/or recommendations------- ------------------- ------- -------------------------------------.--•------•----------•-------------••------------- ----------------- -------------------------------------------------------'------------- -------------------- --------------- --------- ------- ------------------------------------------- -------------' _ ------------ - L FINAL INSPECTION BY:.-------- - Date------ ----- v = -------------------------- 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 E5-9-2M 145446 A-00D 12-54