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j,� -ij - IJ'� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) z/ �� Date issued _�/.='�_- Ap lii: 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 AW LOCATI N..._ :""""""_-•_-"f'GO --------- - - ---- ----- ' Owner's Name--- •- ---- "` ---------------- Phone. -- -•�-- Address----;7:"-- - Contractor's Name . •--•--------•---- ------------------------------------------ -- ----- ----------------- ---------------- Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1____ Number of bedrooms Number of baths -_/__ Lot size -----_?_ !D.'A )-"2J ----------------------------- (.7.0 Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [� Adobe ar 7pn ❑ Previous Application Made: Yes ❑ No [��. onstruction: Yes ❑ No [f TYPE OF INSTALLATION AND SPECIFICATIONS: %(No septic tank or.cesspool permitted if public sewer is available within 200 feet.) Septic tTank�,, Distance from nearest well-----------------Distance from foundation--------------------Material___-______--_____--_____._._ No. of compartments-_., ----------- size--------------------------------Liquid depth--------------------------Capacity------ ---------------- Disposal Field: Distance from nearest well-l5Q_.--- Distance from foundation._-._2'45'-!__.Distance to nearest lot line___,:.5___/.___- Number of lines---------------1----fr"___""--Length of each line_____�Q ----------Width of trench.__�..-�J-'-------- -------------- Type of filter materiaf--J- ------______Depth of filter material-------I_-1-1-�""-Total length---li—a- ------___" Seepage 'Pit: Distance to nearest well------_--------------Distance from foundation-----------.........Distance to nearest lot line___---____.__--__ Number of its_ p ______ ______ - ----Lining material---------- ------------Size: Diameter-----------------------Depth -----------------•-------------- _ __ , Cesspool: Distance from nearest well---------------__Distance from foundation--------------------Lining material__.-___-._.___.----__-_Y __ -----•- ❑ Size: Diameter------------ ----------------------- Depth ------------------------- ------------- # Dth ------ Liquid Capacity-----------•---------------gals. Privy: Distance from nearest well----------.--------------------------------------Distance from nearest building ❑ Distance to nearest lot lire---------------___---.-___._,_-"--___-__"" Remodeling and/or repairing (describe):------------------------------------------ ------------------•----•-------•------------•--------------"----------------•-----•------------------------------•--------•--------------------------•-------------------•---------•----------•----------------------------- ----------------------------------"--------------------•----•------------ -••---------------• ----------•_- --------- ------------- --------•---•-----------------•--------------------------------------------------------------•-------•---------- ----•---------•----•---•--------------------------------------- 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 r� regulations of the San Joaquin Local Health District. 2A - - - (�9dRdfvr Contractor)---- ------------ ---------BY: ---------------- -- I --- --- - Tale - - - - -- - -- -- -- --- --- - -- - - -- -- (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 APPLICATIONACCEPTED BY---------------------------- ----- --------------- --------------------- ----------------- DATE------ ------------------ --------- - ---------------------- REVIEWED BY---------------------------------------- DATE_-_— "_ ___ _________ BUILDING PERMIT ISSUED----------------- - ------ ------- - ----------------------- -------------- •-------------------- DATE - --------------------------------- Alterations and/or recommendations:-------------.........-...-----.---------------------------------------------------------- ----------------------------------------------------------------- ------------------------------------ ------------------------•------------------- -----•-----•------•------•-------•------ ------___ -•---------------------------------•---------.-- ------------------------------------------------------------------------------------------------------------- WFINAL INSPECTION BY:. -- --------•- Date_---------- ----------------------- 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 E5�-•-9—yM 145446 ATWo9O 72-54 r