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�1 APPLICATION FOR SANITATION PERMIT Permit No. .__G__ . Z {Complete in Duplicate) Date Issued Applical-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 - !-_f ____.___.._ Owner's Name--------"v-0- - -------- ....._ _ --------- Phone------------ -.----- •-•- - /� - ---- - ----------------------- Address------------ 1 - - .--•---------------•---------------•-------------------------------- -------------•............... Contractor's Name------- r -- --_. --------------------------•--------- •---------_ Phone-A/A-411_7 f Installation will serve: Residence E, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: � Number of bedrooms ._t_._ Number of baths ___!__ Lot size ---/__40 -----A--lS]�-_ -� Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table z�_7aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ Adobe[9 Hardpan ❑ Previous Application Made: Yes ❑ No a Now Construction: Yes ❑ No JAI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) Septic Tank- ante from nearest well----___.__._-_ _ ___Distance from foundation___________________.Material______-________ __ ❑ J compartments---------- --------- -----Size-----•---------•----------------Liquid depth---------- - ------------.Capacity..----- � Disposal Field:+ +Ante from nearest well-----.-----------Distance from foundation________ _____.Distance to nearest lot line_________________ ❑ r of lines----------------------- ------Length of each line---------------------------.-.Width of trench Ty e of filter material-------------------------Depth of filter material----------------------Total length---------------------------.___-_ , l Seepage Pit: Distance to nearest well____ ._ 2't. 9istance from fo ndation;:_.h----------Distance to nearest lot line-_.____0------ W Number of pits-------1__________._Lining material _ i�e: Dia-meter__ -- 4i f ------ Deptn.......... 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 and/or repairing (describe):--------------------------- ......... - ----------•--•-----------•----a:-- -------- -------------------------••--------•----------•------------------- --- ------------ k --------------------------------•--------------•-----••-------------- q----------------- ------------ I herebyIthat I have prepared-this application and that the work will be done in accordance with San Joa uin Coun ordinances, aand rules and regulations of the San Joaquin Local Health District. (Signed)---- --- 1 _- By=--- ran r Contractor) - o ori ----- (Title).. .__,------------------- --- ot plan, s owing size of lot, location of system in relation fo wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- ---- -------------------------------------------------------- DAT -- - REVIEWED BY-------------- ---------•-------------------- ---- -- --- ----- --------------------------------------------------- DATE----- BUILDING PERMIT ISSUED----------------------------------- DATE. ---------------- ----------------- Alterations and/or recom ndations:_______________________________ y ------- ------------------- ----------------------------- ------- -=----- ---- -------- ----------- -!r ,— ` ----------- ---------------- -•- FINAL INSPECTION BY:_ ---------------•---------------- Date-----/ _�---- .�Z � - ------I-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California 1 ES-9-2M 145446 ATWOOLI 12-54