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APPLICATION FOR SANITATION PER -- � MIT 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_-_ ' ---- - t -- -------- -Owner's ------- Phone Address ----- -•------- Contractor's Name. =-_:: . - -• --- ` .� ------ -- - -- ---- -�- �--�-�-•'�.`r�`-�--- Phone Installation will serve: Residence � ----`--""-- �[0�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other ❑ 'r Number of living units: __ ___ Number of bedrooms .�__ Number of baths --0-_ Lot size ..P Water Supply: Public system gi-tommunity system E] Private ❑'Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe @��'ardpan ❑ Previous Application Made: Yes ❑ No P:" New Construction: Yes ❑ No ' TYPE OF INSTALLATION AND SPECIFICATIONS: 'F (No septic tank or cesspool permitted if public sewer is available within 200 feet.) eptic T nk- Distance from nearest well _._ �% Distance from foundation--------------------Material -----------=--------- ��,. No. of compartments--------- ---------- ----Size ---Liquid depth---------- ------ --------Capacity------ Disposay ield: Distance from nearest well _______ 1 Distance from foundation.----"-------------Distance to nearest lot line._--_:.- -___-- Number of lines-----------------------------------Length of each line-----------_ ---- ----------Width of trench.--------Type of filter material-_-7 ' ' ------- --.---Depth of filter material---------------------Total length-------------------••---=----•---------•-- . Seepage Pit: Distance to nearest well-_ t 'Distance from found tion---- _F____.pistaFye'to nearest lot line--._ _`_- �� Number of pits.--___/____----.-_Lining material_ie- O' , ----------- Cesspool: ! ze: Diameter.---------------Depfin... �' Cess ool: -•--------------- p Distance from nearest well-_ _Distance from foundation------------------ ..Lining material-------------- ---------------------- ❑ _ Size: Diameter--- -------- ----------- ---------- Depth------------------------------------------------ ...Liquid Capacity----------------------------gals, Privy: Distance from nearest well... ----------------------- ------Distance from nearest building------------------- ❑ Distance to nearest lot line-------- "---------------- ---------- - -------------------------------- Remo-deling -- ---- Remodeling and/or repairing (describe):------- ---- -- V s ------•-• - -- a ---------------- ---------- ----•------------------------------------....------ ----•--------------------•------------------------------ ------------- ----------------------------------------------------------------------- .I hereby certify that I have prepared this application and that the work will-'b e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Dis}rict. . g r _ (Signed) ron /t � --- -------•---- -- -)� Contractor Plot Ian, showin size of lo} ystem in tela} Title--- _ - .y( P g ) ft ------- ------- �. ion to wells, buildings, etc., can be placed on revert side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _______.--- ------------ ----------------------------------- y ----- -- DATE - REVIEWED BY --------- ------------------- ----- DATE - BUILDING PERMIT ISSUED---------------- ------------- --- --- DATES Alterations and/or recommendations: - ---------- --------- ----•---- -- FINAL INSPECTION- BY:---- ------------------------ ------ Date.-. - ..................... SAN JOAQUIN LOCAL HEALTH DISTRICT ' { 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "G., $free+ Lodi, California Manteca, California Tracy, California r 145446 ATwoon as