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- f APPLICATION FOR SANITATION PERMIT Permit (Complete in.Duplicate) � Date Issued Application is hereby made to the San Joaquin Local Health District for � This application is made in compliance with County 'Ordinance No. 549, a permit to construct and install the work herein described. JOB ADDRESS -AND LOCATION-_.-- __-/T W �4 ---L--•.-------------� ----Owner's Name ------------ � -Address_ ----------------------------------------- Phone -- � > ------------------------------- contractor's Contractor's Name__.---__ ----------------- ----------- -- O }I Installation will --__.- t - -----------------------•--------------------- ----------------------------------------------- Residenceserve: Apartment House ❑ Commercial Phone______________________ ------------- � ❑ Trailer Court ❑ otel Number of living units: _--�-__ Number of bedrooms -- _ ❑ Other ❑ Number of baths -_: Lot size __---� Water Supply: Public system ❑ Communitysystem Y stem ❑ Private W--Depth to Water Table _- {t- F �Clzaracter of sail,fo a depth;,00,.fee+: :Sand []- Gravel o-4Sandy-Loam- -Clay Loa�r-❑�C-la-' �� . �-^ Previous Application Made: Yes ❑ Na Y ❑i°�dobe ar pan TYPE OF INSTALLATION AND SPECIFICATIONS: YesNo ❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k. NoDistance Como nearest-Wel`. �� Distance from foundation-_-f- �_-_.Materia ---�_� I-, C )—C ' r P �-------Size------- '�=> Liquid depth ---------------------- ------ Disposal Field: Distance from nearest we l_- "__Distance from foundation_- _ ........Capacity-_-_----------------- Number of fines----_ --_._ Distance to nearest lot line.--- it--Length of-each line---- -- .... -- ------ Type of filter material_ -� - f� Width of trench-_--_ _ Depth of filter material------j, _"-- ----Total length----------fes---- �- Seepage Pit: Distance to nearest well--_------- go-- Distance from foundation..---..--"-..._---..Distance to nearest lot line__---_-"-----_--_ ❑ Number of pits......----------------Lining material-----------------------Size: Diameter Depth -------------------- Cesspool: Distance from nearest well---------_--_---Distance from foundation---__-J-__---_--_ ,Lining material__-_------_"--_ ❑ Size: Diameter_ Privy= ----------Depth-_.---"-----------------------:---------------------Li uid Ca aci Distance from nearest well "' q P -------------------- --gals. ❑ Distance.to nearest lot line ----- ----- --_--_"-_-_-_--__ ------------------`Distance from nearest building--------------------- ------------------------. .----------- ---- --------- -- Remodeling and/or repairing (describe):--_--__--_-___,/ �'✓� Y -------- --------------- ------ ------ --------- --- --------•-------•--------------------------------------------------- ---- -- I hereby certify than I have prepared this application and that the work will be done in accordance with San Joaquin Country ordinances, State laws, and rules and regulations of San Joaquin Local Health District. (Signed)_._ - ----------- ---- --- ---- ------- -- - . ----------------------------------------------------------(Owner and/or Contractor] (Plat plan, showing size of lot, location of s+em in relation t ells, buildings, enc., can(belep cad on reverse side]. --------------- OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__--_- -_-- . Rl�ljwVIEWED BY ATI . --- - ILDING PERMIT ISSUED-- -----------------•-------------------- DATE -------------- aerations and/or recommendations:---------"-__--- ----------------------•-"----- " -------- DATE------------------------------- ----------- ------------------------ -- --�- ----------------- i_-_- ------------ --------------- __- - 1 r ' ��rL.d. __. _ --------• -------- -��- }_ ------------ = - - --- I/fi --------------- ------ FINAL INSPECTION BY:- •_- -.--• -------------- Date ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreef 300 West Oak Street Stockton, California f32 Sycamore Street L 814 North "C" Street odi, California Manteca, California Tracy, California E5—•9-2M 8-51 Revised W-2100