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APPLICATION FOR SANITATION PERMIT Permit No. ��/-'' 41 (Complete in Duplicate) Date IssuedApplication is 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 O dinance No. 549. JOB ADDRESS AND LOCATION----------- / 1 4-------- ' ° ------------- ---------------------------------- --------------------- �� -� ------------------------------- -f ---------- - --- Phone /�G ' Owner s Name--------• -----• � �� --�� -- ---�- ----- - - - - --- "' 4 Address ' s -- Contractor s -Name---------------...."--------- ------------------ Phone_-"-'7n-YK /- ---------- Installation will serve: Residence Apartment House ❑JJ Commercial ❑ Trailer Court ❑ Motel ❑ Other- Number of living units: _ ___ Number m bedrooms _-!:3__ Number of baths _Y__ Lot size _ �]"�-L•�Q.'�------------------------------ Water Supply: Public system A Community system ❑ Private ❑ Depth to Water"Table 1 __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loarn ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ 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 foundai-ion--------------------Material________---___________.________-_______________- No. of compartments---------------------}----Size-------------------------------Liquid th Capacity Disposal Field: Distance from nearest well�J1� d---Distance from foundatio -----------------Distance to nearest lot line_,__---.____ . Number of linesLength of each line_-_sem Q_'�--------Width of trench---s ----------------- --- Type or` filter materia_ &P Depth of filter material___- _.jV----____Total length__-_ 'C) i i Seepa e Pit: Distance to neares well- QY - .__-Distant f o fo ndation_s _____________Dqn c toDn p+est I� �___Number of pits__________________Lining materiah� -.Size: Diameter- „�- Cesspool: 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--------------------------------------------- -------------------------------------------------------------------------- -------------------- Remodeling..a, V/& r /or re firing ring ___/ ------ •---- G -x r�- I hereby certify that I h ------------- repaired this application and that the work will be done in accordance with fan Joaquin County Y ordinances, State I a rules d' regulations of the San J in Local Health District. -_____ Contractor) [Signed)-- �-- --- - --- �-Wiz`-�-�-- - ------------ --on-1 -`_ —�---r Y:--------- --`-------- --- --�- -------- ----------------------------[Title) (Plot plan, sho ng size of lot, location of Porn in relation to wells, buildings, etc., can be pi ced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -------------------------- ----------------------------------------- ----------------------------------------------- DATE__/4__' ------------------------------------ REVIEWED _ ,_ -- --------------------- ---------------------------------- Alterations ----------------- - t f�TE- �t• f.. _ '' -y REVIEWED BY `� BUILDING PERMIT ISSUED----------------- �� - ---- ;�, _ -__ _--_----____ -------- -� � h i^,--- - - -------- moons and/or rye mmendations:___ "_F_ _ .__ P ''1 'GF '� ' Alterat� _ ! • --------- ----------------------------------- -- � ------------ ---- ---- ------------------------------------------------------------ r . _ ,. - 1 1NAL INSPECTION BY: = __:. Date �.a. SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5--9-2M 8-51 Revised W-2104