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APPLICATION FOR SANITATION PERMIT Per No. K (Complete in Duplicate) Date Issued gA plicaflon is hereby made to the San Joaquin Local Health District for a permit to construct and in-stall the work herein' described. This application is made in compliance with County Ordinance No. 549. J -ADDRESS A7ND'L ATION------------ __Z) (=1i-------- --------------------------------------------- OB .Owner's Name ---- -- --------------------------------- ------------------------- ------------ Phone-------------------- ---------- Addre'ss ................ .. 1��------------- - --- --------------------------------------------- ------------ ............. ----------------------------- -7 ........ --------------------------------- Phone- 7 Contract6r's Name.. --------------------------- Installation will serve; Residence 99.-Apartment House E]- Commercial E] Trailer Court E] Motel E] Other El Number of living units: Number of bedrooms _tZ,-Number of baths J--- Got size __-----r' __IF--------------_-_ Wat F------------------ Water Supply: Public systern dg- Community systern E] Private ❑ Depth to Wafer Table ff. Character of soil to a depth of 3 feet: Sand 0 Gravel El Sandy Loam E]. Ciay Loam E] Clay E3 Adobe a_Hardpan E] Previous Application Made. Yes E] No New Construction: Yes; No No F-1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200 feet.} p 4 Septic Tank:. Dis ' e from nearest well_----------------Distance froG foundation------- ------------Maferial----------------------------------------- ------- 0 m0artmenis.---------------------- Size-'_---------------------------Liquid depth--------------- ---------Capacity----------------------- Disposal apacity------__------------ D;sposal Field: Distan; ,.,�rom nearest well....-- Distance from-foundafion--------------------Distance to nearest lot'line----------------- D T� ype ---------------------- --------- -Length of each line---------- ...............Width of trench------------------------------ 'Iter material--------------------------D6l6fh of Pilfer material.----.--.-------- length------------------------------------------- Seepage Pit: Y Distance to nearest we1L. . Qtistance from founclation___6�4-------Disfance to nearest lot line--- Number of pits--------- -----------Lining material__ "iame_ter------ Depth----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------ -------- ------------------ h------------------------------- - --- -- -- - --------Liquid 'Capacity----------------------------gals. 0 Size: Diameter--------------------------------------Dep 1-4 Privy: Distance from near'est well_________________ --- -------------------Distance from nearest building__--------:--.---_------_..._-----_.----.- El Distance to nearest'lot lire----'.__•% -------------------- ..........r_: ------------ ------------------------------------------------------------------------- P Remodelingand/or repairing (describe}:-----_-------------------------------------------------------- -------------e-------------- - ---- ------•--.....-------------------------------- -----------------------------------------------------------zm--------------------------- ------------------------------------------------ ------------------------------------------------ ------------------------------------- -------------------------------------------------------------------------------------------------------4-------------------------------------------- ----------------------------------- I hereby certify_.1hat I have prepa;ed this application and'that'the work will b6 done in accordance with San Joaquin County ordinances, a - and rules and,regulations of the San Joaquin Local Health district. (Signed) - - --------- --- ------ ------ -----------------------------------------(Owner and/or Contractor) By------ -- ----- -- - ---- .50------ - --------(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------I ------1�__,;;�o---- BUILDING PERMIT ISSUEDDATE--------------- -----------------------------____ ----- ---- ------------------------------------------------------- DATE--------------- ......t.,,;7 ---------------------- ------------- Alterations and/or recommendations:.-.--_---------------- .......... ---------- --------------------- -- ------- -------------------- ------------------ --- - ------------------------2,_ ...... ------------- % --- ----------------------- ----- -------•-------E-------------------- ----------------- ---------- ---------------------- . ......... .. .. ------------------------------ ---------------- - - ------ 5foe A A-4 ------------------- ---------- ....... -------------------- ------------------------- ----------- ----------------- -------------- ------------------------------------------ --------------------------------------- - FINAL 'INSPECTION -------------------------------------------------------------------------- ............. -------- -------------- Date---- or SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California F:F_, 9 6 A .D