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1 ( APPLICATION FOR SANITATION PERMIT Permit No. , (Complete in Duplicate) �►^ _ � Date Issuad", ._.�.:.5_' Applica+ionis 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 AlDD ATI ----- ----- -- ............. ---- --=-- ---------------------- Owner's Na ._..._ - Phon / ? Address. _........_ . . __ .... - ` -- - -.... -- ....- - - - - 9 Contractor's Name.....- - _... r. . . - .......... - - - Phone>r-----`'r .---------- Installation will serve: Residence'' Apartment Ouse ❑ Commercial L] Trailer Court, ❑ Motel ❑ Other n �/ `� Number of bot 4 r Number of living units: -_f.. Number of bedrooms Number 6s .�... Lot size - ....X.. '..'......._...._........ Water Supply: Public system Community system F] Private F] Depth'to Water Tobl�Qft. Character of soil to a depth of feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobwk� Hardpan ❑ \ Previous Application Made: Yes ❑ Nes New,Construction: Y 14 No'❑ TYPE OF INSTALLATION AND SPECI'FIC`ATIONS: \ ` (No septic tank or cesspool permitted if public sewer is available within 200 feet.) V Septic'TT A. Distance from nearest well.......__.._.-Distance from foundation._..__..._......Material.._.........._. ........_--------------- --- jo No. of compartments:_.-...---.---,_._Siie--:-_-----------...--- -.Liquid depth--- -------------.Capacity......._......... .---- . \\ Dipos F, d: Distance from nearest well- ...--...__-_Distance from-foundation.-_......_........Distance to nearest lot line................ Number of lines ... Length of each line--.. .. . Width of trench ... .: --- Type of filter material .. -.Depth of filter material... , ..Total .length ..- .... . - ...... Seepage Pit: Distance to nearest ------Distance f rr�foun tion/Q... Distfnce to nearest lot line .1r �... Number of pits... .. Lining material- .. .Size: Diameter. ........._ .Dept h ... 'U .... Cesspool: Distance from nearest well.... ......Distance from foundation ........ Lining material .. ..__._...... ❑ Size: Diameter.----_------...... ........._..._Depth---`----------------.... Liquid[ Ca acit ___ ............__...---Li ui p ,y_. . ........__-.-._gals. Privy: Distance from nearest well-----_.... ... ...--....... _.........Distance from nearest building--------- _.._ ... ❑ Distance to nearest lot line _ - ^� __ __ - - .. � 4 - - Remodelin fo re a' ' q�describeJ - - -------------------------------____---------------•-------------'---------------------------------------------------.............----------------------.._------ ---__.------------_ .. I hereby certify that I have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinancas:.St laws, and rules and re la-K6 s of.the San Joaquin Local Health District. (Signed) - -- - ------ --- .... ------ -------- - ._.._.._..- -. ... Owner`m�`�3econtractor) --`- --- -------- ........ ---------------- ---------------(Ttle (Plot plan showing size of lot, to ion of system to relation wells, buildings, etc., can be p on reverseofde) oeo FOR DEPAR"MENT USE ONLY APPLICATION ACCEPTED BY - -_ _ .. ......... ... DATE j B REVIEWED Y _. .- C�c1- . . DATE .. m BUILDING PERMIT ISSUED. ....... ............... ��\ . ... DATE Alterations and/or recommendations; .. . ...-_ - y --_. ._ __ ._ - -:_ - .. � ..._. .. -----------:.......... . -------------- .. . ... . .........--- --- . . - .........................-................ . . .. . ... . . ... .......... ,.. ......... ..--•--- ------- ------------------------- --- .. .... . _._ ................................-------- ........................... . , . . ----`-r----------- --------.....—`.--------.-----.........................._...__... _.------_....._._.._ BY:. FINAL INSPECTION . SAN JOAQUIN LOCAL HEALTH DIST]l 130 South American Street 300 West Oak $treat 132 iycamore $'•oat 814 North "C" Street Stockton, California Lodi, California r Me toce, Celifor.ie Tracy, California ES-9-21d +- Revisod W-2100