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APPLICATION FOR SANITATION PERMIT 'Permit No. ..... �-� (Complete in Duplicate) S Date Issued 4 Applica+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. —•• e2_ lf ------------------------------•------------------------------- _ JOB ADDRESS AND LOCATION--._--e2_f __ Owner's Name.-_*. ----------- Phone----••----------------------------- _ Address- ----------------------• --•---------------------•------.--------------------------------------------......... ? J1 Contractor's Name -- ------ Phone Installation will serve: Residence 1p, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.i___ Number of bedrooms _,*3_._ Number of baths _-I____ Lot size ----- --X- 1 Water Supply: Public system` Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J) Hardpan ❑ Previous Application Made: Yes ❑ NoNew Construction: Yesv No ❑ M1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Distance from nearest well------------------Distance from foundation--------------------Material-------------------------------------------------- No. ___.-__--------__.___..__________--____________.-No. of compartments-------------------- ----Size-------------------------------Liquid depth--------- -- -- --------Capacity----------------------- Disposal Field: 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 well--_- '` Distance fr m toun ation__l_e)___.._.___.Distanie to nearest lot lin t� Number of pits....... !..........Lining material__ Size: Diameter------ Depth---r2 ---------------------- Cesspool: .- pool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------_._______________ ❑ Size: Diameter----------- ----- - ------------------Depth---------------------------------------------------Liquid Capacity-.---------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest budding------------------------ ❑ Distance to nearest lot line-------------------- ------------------ -------------------------------------------�------------------------------ ------ s Remodeling and/or repairing (describe):__ . ___-___.__..___ /.�• •l r- —~? ---------•---------------------------------- ----------------------•--------- ------ -------------------------------------------------------------------------------------------------------------------------------------------•-------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with Sart Joaquin County o ordinances, lamf7pW rules and regulations of the San Joaquin Local Health District. __(Owner and/or Contractor) Cr (Signed) < -- -------------------------------- - --- -- ----------- ,,,,,, } /j Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 1 APPLICATIONACCEPTED BY� ------------------ ------------------ ---------------------------------------- DAT�---------------------------------------------------- REVIEWEDBY-------------------------- -- - -------- ----------- ----._ DATE-�------------------------------------------------------ BUILDING PERMIT ISSUED---------- ------------------------------ - -- -• DATE---� - -� --------------------------------------------- Alterationsand/or recommendations:_ -------------------- ---------------- --------------------------------------------•---•--•---•----------------------•-•--•--------------•------------- ---------- ----------------------------------------------------•------------ - --------------------------------------------------------------------------•--------------- -----------•---------------------- --------- -------------- ------- - -------------- - ------------------- FINAL INSPECTION BY::� -------------------------- ------------ - -- — � SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street 'Stockton, California a�- Lodi, California Manteca, California Tracy, California -, E3-9-2M 145446 ATWUUD 12-54