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APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date Issued ---------�2 q-3 A aper it Ict 3-300,0 This is hereby made to the San Joaquin Local Health District for a e into construct and install the work herein described. is application is made in compliance with County Ordinance No. 549. �K'Ce7 r- - -------------------- v JOB ADDRESS ANP OCAT19N.6 O--` ------------ 4W Owner's Name------- A ---- ------- --------------------- --------------- -------- ---------------- Address---------------------7- ----------------------- -- --------------------------- ------- ------- ..........--------------------------------------------------------------------- ----------- --------------------------- Phone----------------------------------- Contractor's Name-------- -------- ------ Installation Will serve: Residence Apartment House E] Commercial [-I Trailer Court 0 Motel 0 Other El Number of living units: -/-.- Number of bedrooms -R-.- Number of baths --/--- Lot size _-_-_Q -- -- ----- ----------------------------------------- Water Supply: Public system El Community system El Private lq--Depth to Wafer Table -Rjr-'4ft. Character of sail to a depth of 3 fee+: Sand E] Gravel E] Sandy LoamClay Loam [:] Clay 0 Adobe 0 Hardpan El Previous Application Made: Yes E] No �New Construction: Yes triN'o'o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sepfic>a k: Distance from nearest well-- Distance from founclation--.0---------Material----Ole-1-Alft-1 No. of compartments-----4-- - ---------S i z e - .tP---Liquid dep.fh-------- Capacity----------------------- Disposal Reid: Distance from nearest well...1$,-0....Di5fance from foundation_____& _.._.Distance to nearest lot line.--4r------- Er-14 Number of lines_______ --- -,--Length of each line-------7,177� Width of french_.__a ------------------ Type of filter material-/ -�,--'-Depth of filter material----- lif-*-------Total length-------Z!.:� ------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_____._._________ ❑ ine----------------- El Number of pits----------------------Lining material--------•--------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: epth------------------------------- -Cesspool: Distance from nearest well-------- --------Distance from foundation...._._..._._-----.1ining material--------- --- ------------- El Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________._ ._Distance from nearest building----------------------------------------- El Distance to nearest lot line-_______ --------------- ----- ------ ------- ---------------------------------------------------------------- ---------- ------- Remodeling and/or repairing fdescribe):--- --- -------- --I-------11�-------------------------I------------------------------ ....... ------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------- ------------ ---------------------------------------------------------------------------------------------I----------------------------------1------ ------------------------------------------- ----------------- --------- ----------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ 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. -vnd�er Contractor) (Signed)------- ---------------------------------[G*nvr By.. -------------------------------------------------(Title)----t- Z------------ I- 05-7" ............ . -------- (Plot plan, showing six of lot, location of system in relation to wells, buildings, etc.', can be placed on reversede). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.. ---- - ---- - - ----- - ----------------- ---------------------------------------- DAT coz, .. . ... .... F---------------------------------------------------- REVIEWED BY-------------------- 1 ---- --------------------- ------------------------------------------ DATE -Zi-------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----:7E---------------------------- Alterations and/or recommendations:---------- ----- - -- ------ ----------------------•--------------- ----------------------------- -------------•-•------------------------------ ------------------------------- ---------------------------------------------------------- ---------------------------------------------------------------------------------••----------•------------------------------------ -------------------------------------------------------------------------- ------------------------------------------------------------------------------------------ --------I----------------------------------------------- --------------------------------------------------------------------- ---------------- ------------------ ------------ --------- - -------------------------------------------------------------------- - ----------- -------- ------------------*11--------- ------------------------------- FINAL INSPECTION BY:- - -- - -- --- ---- --7-------------------- Date............ --- --------- ------ M4 ----------- 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 175-191-21`1 145446 ATWUDU 12-54