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c� APPLICATION FOR SANITATION PERMIT Permit No. f� (Complete in Duplicate) Date Issued --- y 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. rr rr P e --�� --- JOB ADDRESS AND.Lre� TION - 1 Y `��-- 4 -------- ' Owner's Name...__--_ ---- ---------------- ----------------- ---------- 1 ! �— Address-_......� 1,1 .... s-6---im------ r -----------•-------------- Contractor's Name-------- ys.Y -_Z71_V C-f------------------------ -------------------------------------.......... Phone..A�_-h--4--'/c_4.7. Installation will serve: Residence %_�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..../_ Number of bedrooms _-: -_ Number of baths .-1._ �4 - Lot size .----- 5-- _-._-"lQ_G-"--r---------------- Water Supply: Public system ®Community system ❑ Private ❑ Depth to Water Table -------- ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[[].,,Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No 0— TYPE —TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- /f' Distance from nearest well--;--------------Distance from foundation--------------------Material---__-_____--___------.----------------------- ❑�' rstrO? No. of compartments----- --- --- ------- ----Size-------------------------------Liquid depth---------------- --------Capacity------------------ --- Disposal Field:/, / Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line.---.---_------_- ' ❑ ,�Xt��tK/ Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- -1 of filter material------------------------- of filter material----------------------- length------------------------------------------ Seepage Pit: Distance to nearest well/I16_AI/E.---Distance from foundation--;�-,P---... .Dista--c-e to nearest Eo " �----• ®� Number of pits----------! ________Lining materiaSize: Diameter.-_2-�-n ------. Depth-_41 epth-- --��-"�- 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__-_____ -------- ' `6--�ciyl-_-----�!_�1�1 -[ ----------------------------------------------- `�`� Remodeling and/or repairing (describe}:___.----�� ..(/ ----------------------•-----•-•-------•----------------------------------------------------------------------------•-------------------------------•--- --------------------------------------•------------------------ --------------------------------------------------------------------------------------------------------------•---•--•------•--------•----------------------------------------------•-----•----------•-------------------- --- --------------•---•----------------------------------------- ------------------------I•---•-------------•------------------------------------------------------------------------------------------------------ --------- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Signed)------aa- (Plot �_ "-"-�47�lVC f Ziner and/or Contractor) ----- ---- ----------------------------------------------------------------- 10 By:- ----•- ---•---------(Ti+le)------ ------------------------ ... plan, showing size of lot, location of system in relation to welis, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y -------- ----- DATE --------------------------------------- R EVI EWED ---------- ---------------- -------- REVIEWED.BY------------------- ---------- ---- ------ --- ---------------------------------------- --.. DATE-------------------L--------------------------------------- BUILDINGPERMIT ISSUED------------------------------------- --- ----- --------------------------- ---------.- DATE--------------- Alterations and/or recommendations:_-__-..___--------------- -- --- - `------ ----------------- --------------------------- ----- --- ...---- --------------------------- - -- -- FINAL INSPECTION BY:- - -------------------------------- Date------------------------------------------ -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oat; Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, Califcrnia Manteca, California Tracy, California ES-9-2M 14544S ATWOOO 12-54