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got y �Y�S° APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) ' Date Issued ---------a14 Applica+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. `fir r JOB ADDRESS AND LOCATION_....?Xe1/f ----------------/ /-� - --------- � _ :.,1 �d1 Owner's Name.-------- ---------------------•--- ------------------------- - ------------------------------- Phone-------------------------------- Address----------------------- Contractor's ----Contractor's Name----------•------------, f_e--•-- -4,-0V 4'/0'--.--------- �-lam -----------. Phone-_..--•-•----------- - ... Installation will serve: Residence E] Apartment House E] Commercial E] Trailer Court Egj- '/'�otel E] Other p Number of living units: _,(�__ Number of bedrooms __ Number of baths J-.. Lot size -__-p?--- _ ` Water Supply: Public system M-l"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 94-14_�_rdpan ❑ Previous Application Made: Yes ❑ No k-_-;7New Construction: Yes [_1 No RD— TYPE D--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) I �Sep�,ic ank. Distance from nearest well------------------Distance from foundation--------------------Material _-_-_-__-..-_-_-_-_---._-______------__...__._. No. of compartments-- Size----- --------------------------Liquid depth------------------------Capacity----------------------- ispos�l Id Distance from nearest well.................Distance from foundation____- .-----.___.Distance to nearest lot line----------------- Number of lines____________________._. 44- -----------Length of each line------------ ------------------Width of trench--------------------------------- Type ------- ------------ ----------Type of filter material---------- --------------Depth of filter material.....-----_------------Total length----________--__________--------_--------- ,.. „e Seepage Pit: Distance to nearest well_/&F� __Distance from ou_ndation_ Eby -- - -= � ��1__...__..Distao�e to nearest lota�line..`._..__.___ . Number of pits------- ------------Lining material-L.��. l 'Aize: Diameter--- �-----------Depth------ref- --'"r-----.--. \ 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--------------------------------------- El Distance to nearest lot line------------------------------------- ---------------------------- -- ----------- ------------------- Remodeling and/or repairing fdescribe):._.___.._-.___.___- �- • � -•-• - ---•-•------------------- { ----------------------••--•---•----------------------------------------------------- C a ------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------•--•-•---..-..------------------------------ 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 rule and regulations of the San Joaquin Local Health District. t (Signed)......_.. P P iva; {©wrzar Contractor) -•-•- --•--------- + �. By:-: {Title} ? - i (Plot plan, showing size of lot, locat' of system in relation to wells, buildings, etc., can be placed on reverse ide). FOR DEPARTMENT USE ONLY APPLICATION ACCFPTED BY------------------ ------ -- ------------------------------------------- DATE -•--------------------- REVIEWEDBY------------------------------------------------- ---------------------------------------------------•--•----------. BUILDING PERMIT ISSUED --- --•- -- ------------ - DATE '� - Alterations and/or recommendations:-------------- . ~ - -- ------ - ----------------_------------ -- -- _------------------ ----=�---- } ---c----- --�------------------ -----------•-----------•---•---••-------------•--•------------------------•------~-_-------------- ------ •--•-- -------•--------- -------•--•------ - ------------------------------------------- --•----•- ............----------• ------------ ------- r FINAL INSPECTION BY:....0 � Date----- r i 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 es—g aae A1.00D f