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APPLICATION FOR SANITATION PERMIT Permit No. ...._x __7--6.. (Complete in Duplicate) Date Issued --- 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. JOB ADDRESS AND LOCATION----------8 Owner's Name..-------.-j�--_alv_ Phone ------------ 1 ---------------- ----- - ------------------: Address. { , rs' 1`�7 Q-----------------------...-•----•---------•------------- --------------•• -------------------------------------• -------- Contractor's Name------ 0.-�L _ ---•-- —------- -- Phone - r Installation will serve: Residence [s Kpartment House ❑ Commercial ElTrailer- Court ❑ Motel ❑ Other ❑ a Number of living units: {------ Number of bedrooms ___". umber of baths .1---- Lot size --------- . Water Supply: Public system Dq--Community system ❑ Private ❑ Depth to Water Table 41-"_ ft. C Character of soil to a depth of. 3 feet: Sand.❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 5�_ Hardpan ❑ Previous Application Made: Yes ❑ No g_New Construction: Yes Dk_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic Tank: va,nce from nearest well--..-____---.___Distance from foundation_----------------Materia------------------------------------------------- ❑ f compartments- - ---------------------Size---------------- Liquid depth---------------- -------.Capacity-:--------------------- Disposa4��ber ldDitance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line.--_--.----.____- ❑ of lines---------------------- Length of each line--------------- --------------Width of french--------------------=--•----------- s ype of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ o r d t am__-_�_-----Dista iye to nearest lt line---- ---.f---- Seepage Pit:, Distance to nearest well �"P'+RL7'stance from foundation__.c ' 3$------ ---Depth.-.-- ---------------- Number of pits------�__.---..___--Lining material-�..�- -------- : Diameter--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------------------- 0 Size: Diameter---------- ------ --------- - -----Depth-----------•----------- -----------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well ----------------- ------------ -. --Distance from nearest building------------------------------------------ ------------- ❑ Distance to nearest lof line-.----- ----------- ------- ,. Remodeling and/or repairing (describe):----------------------- - ----..-----------------------------•---_..---------•-------------------- •--------- --------------------------- --------------- ------•-----...---•-- --------------------------------------------------•---• ------•----------•--•-------------•------•------------------------------•-------------------------------------------...-----....------------------------------------- :r 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 an regulations of the San Joaquin Local Health District. (Signed) " - (Owner and/or 5� ------------------------(Title)--.-. =`--------------------------------------- (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------ ='. =----------- DATE- REVIEWED BY------------------------------------------------ ��- ---------------------------------------- BATE BUILDING PERMIT ISSUED--------------------------- DATE - ---- ------------------------------------------------------- Alterations and/or recommendations:---------------- ----•---------- -------------------------------•------------------------------- ... ---------------------------- -------------•- -------------- --- -----�------------------------- ---------------- .-------- -- ----------------------------------...- --------=- ------------------- - - --------- y . - --------- ---------------------- ----------------------------------------------------- u ---- ------------------ -----------------•---------------------- ---------------------- Y � --------------- ---------------- -------- ----------- ------------------------------------- --------- -------- FINAL INSPECTION BY--------- ------- ----- - Date--- = CR- - �~ ------ ------------------ FINAL 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 n E5---9-2M 145446 ATwonD 12-54 -