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APPLICATION FOR SANITATION PERMIT Permit No. ____---AK (Complete in Duplicate) Date Issued ________�31s_� Applica4-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 LO ATION___-_--___ __ _ ___.__ .-. Owner'si Name _ ce-1Z ---- ... ...... ..... Address s1 ......---�..... Contractor's Name___ •- ��.- � _ __ Phone----------------------------------- Installation --- - ----- - �--�--�-•-�`------- Installation will serve: Residence QL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __Z__ Number of bedrooms _—"K_ Number of baths .r____ Lot size ---- ---------------- Water -----_----.-_•_ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .A 0_4ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [tom Hardpan ❑ Previous Application Made: Yes ❑ No R�_ New Construction: Yes J_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__;___-_----_--_Distance from foundation___________________Material______________.__.__-----_____________________-. ❑ of compartments--------------------------Size-------------------------------Liquid depth---------------- ---------Capacity_...------------------ Disposal Field: Disfance from nearest well.................Distance from foundation--------------------Distance to nearest lot line____-___-______.- ❑ ber of lines-----------------------------------Length of each line------------------------------Width of #rench----------------------------------- T e of filter material________________________Depth of filter material--------------..._-----Total length---------------------------------_-___-_-- r Seepage Pit: Distance to nearest well---/1./j_?U4-$istance from foundation__�d__..___.Distance to nearest lot 54-- Number of pits--- _-------------Lining material____ __.Size: Diameter__ e _ Depth ______________ rr .`U Cesspool: Distance from nearest well-----------------Distance from foundation- ---------,----Lining material_____________.____.______ ---------- ❑ Size: Diameter--------------------------------------Qepth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest we€I--------------------------------------------- ---Distance from nearest building------------__ --------------------------. ❑ Distance to nearest lot line------------------ ---------------------------- Remodeling and/or repairing (describe)---------------------------------------------------l---....._.-----------------------------•-------- --------------------------- -----------------•---------------•---------------------..._..----------•-- •-------------------•---.-•--•---------------------------------•-----•---••---------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District_. ---- -------- ---- -1----------------- -------------------------------------------- --------------------[Owner and/or Contractor {Signed}------ ----------- :- By:--- - (Title) �" ---------- (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 APPLICATION ACCEPTED BY-- --- DATE REVIEWEDBY------------------------------ -------------- ------- -- ------------------- ------------------------------------------ DATE----------- ---- ------- ------ BUILDINGPERMIT ISSUED----------------------------- --- -------------------------------------------------------------- DATE----- - Alterations andjor rec mmendatio + r� �-e - --- :_ x.11--- . � ------ ---------------------------------------------V--------------------- C _________________._______.____._____._..__----_.._.__.--__._._.______..______.__._ _.-__-___.___.__._.____..___--____________--__._.---------._______...________._.-______._.._-.._____._.__-_____._____....___._ __ __________________________ -..___.----_____--____-- -__ __..__._..______ _.. _____...__.__________.__---- ____._______.....___._-___-________..____--__ ------------------------------------- FINAL INSPECTION BY:------. ------------------------•------- Date---C�. ------- -------------- 7------------------------------------- SAN ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street _014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E°' 9 145446 arwnoo