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/- I APPLICATION FOR SANITATION PERMIT Permit No. _-_p-_6 S (Complete in Duplicate) :-_..•_ Date Issued ----1-------- --------- Applica{ion is hereby made to the San Joaquin Local Health District fora permit to con rust and install the work herein described. This application is made in compliance with County Ordinance o. 549. 1 _ ----------------------•----------------- ----------•------- - ' _ - - - - ----------- -- -- ---- -------------- oJOS ADDRESS AND LOCTION - PhnOwner's Name_---- Address_ f fLr ------ - ---------------------------------------------•-----•-•-------------------------------------------------------------------- Contractor's Name------- - �-- ------ Phone------------ Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court [3 Motel ❑ Other F] Number of living units: _ _ Number of bedrooms #___ Number of baths .1- Lot size ------r;P- __________-______ Water Supply: Public syster> Community system ❑ Private ❑ Depth to Water TabIE�_ G ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adoba Hardpan ] Previous Application Made: Yes ❑ Noyg( New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: W l (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic T k: Distance from nearest well-----------------Distance from foundation__------------------Material_________-----___-_-- -------------------------- No. _-_____No. of compartments----- ------------------- Size--------------------- ----------Liquid depth--------------------------Capacity----------------------- Disposall i Distance'from nearest well-----------------Distance from foundation------------------.-Distance to nearest lot line----------....... + Number of lines-----------------------------------Length of each line-_----------------------------Width of trench----------------------------------- '. j Type of filter material ___.-.-_-_-------------Depth of filter material----------_------------Total length____--_-_______________-__-___________ IE Seepa e it: Distance to nearest well,/."--_Distanc�om.f' dation__/eP__ tante to nearest lot line_- V,` Size: Diameter-`� Number of pits------ --------------Lining material . p Cesspool: Distance from nearest well---_-__-___-_-_-Distance from foundation--------------------Lining material-------------__--_____---_-------_-� ❑ Size: Diameter---- ----------------------- -------De th--------- ---- ------ ------------------ - --------Li uid Ca Capacity_ als. Depth q p Y 9 1) 11 Privy: Distance from nearest well----------------------------_-___-_--.---------Distance from nearest building------------------------------- ❑ Distance to nearest lot line--- ------------------- ---- -- - ---- - ----- - ------------•- -----------•--- Remodeli pairing (describe):_- ----- ---------------- ---------------------------•••----------------------------------------------- -------------- - I ------------•-----------------------------------•------------------------------ ------------_-_-------------_------•--------------------- ------------------ ----- ---------------------------- -----------------------•-----------•----•---•--------------------------------------------------•--•------------- ----------- ------------------------------------------------ f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ty". regulations of the San Joaquin Local Health District. (Signed) ------------------ --------------- (Owner and/or Contractor) -- ------tem in relation to wells buildin s;�etc.�--� .{Ti41e)-4ced - -----------------------------------------By: --- - (Plat plan, showing size of lot, location of system g an.be:preverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------ -- ----- ----------------------------------- ------ DATE------ - REVIEWED BY-------------------------------- ------- ------ ------------ --------- -------------------------------------- DATE--- --- - ---�-- -- BUILDING PERMIT ISSUED--------------------------- ------------------------------------------------ -------- DATE-------- -- - ---- *f Alterations and/or recommendations:__________________ --------- •------ -------------- ----- - --------- ------_---------- -------------- -- --- ------------------------------------------ ------------------------------------------- ---------- ----------------------- ----------------------- --------------------------- ------- -------------------------------------- - ----------------------- ------------------------------- -- -----------•--------- ----- ----------- •--------- - ------------ FINAL INSPECTION BY: -5 Date------- --------------------- f� ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oek;;Street 132 Sycamore Street 814 North "C" Street Stockton, California . 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