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1� s APPLICATION FOR SANITATION PERMIT Per (Complete in Duplicate) Date Issued ------I-_�C - - Applica+ion is hereby mare 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 o. 549. JOB ADDRESS AND OIC I N------... - 7 --------------••- --------------- Address ------------ Owner s Name ' Phone of c3 c�3 Address---------�'SQ� �I _ . ..._ ------ -• ---- - .�26/ 6 ! Contractor's Name---------II - --r =-- ------ -------- -- -- -- -- ---- - -------------------------•------------------------------....-- Phone-------•---••---------------------- Installation will serve: R�khhidence 930"Apartme;t House E] Commercial E] ;Trailer Court E] Motel E] Other E]Number of living uiits: --- Number of bedrooms - __. Number of baths -- _---- Lot size ----Sid-_--.�-----------------�--- - Weter Supply: Public system ❑ Communitysystem Private ,R/De Depth to Water Table - Y ❑ L�" p ��+. I Character of soil to a de�hh of 3 feet: Sand Gravel Sandy Loam ❑ Clay Learn Clay ❑ Adobe �rdF]pan Previous Application Madel: Yes 0 -No Ne ❑ El Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank ortqesspool permitted if public sewer is available within 200 feet.): Se ti Tank: Distance from nearest well-----------------Distance from foundation----.--_r:..----.-.Material---__.-----.______------_--------___----- No. of. compartments-- - -- - ---------------Size-------•-----------------------.Liquid depth------------------------ Capacity------- --------------- ispo al Field: Distance from nearest;weil-----------------Distance from foundation-------------------.Distance to nearest lot line.----------._-_-- LNumJr of lines----------------`------------------Length of each line------------------------------Width of trench----------------------------------- Type 9T' filter material---- -----------/-----Depth of filter materia --------------------- length-------------------------------------- -. Seepage f: Distanhe to nearest well----7.Sr_.__-__Distance f�r 3m foun -+ion=- �S /Distance to nearest lot line-- ![ NumbeIIr of pits----- --------=----Lining material[-`'-c_�ze: Diameter---33.............Depth----�5--_----------------- Cesspool: Distance from nearest well-----------------Distance from foundation....-. __.Lining material-----._--------.______-----___--_-. ❑ Size: Diameter.-- _----- -----------------'Depth------------------------ ----- -Liquid Capacity-..: --- -----------gals. -f Privy:. Distance from nearest-t yell.................................................Distance from nearest building.-------------------- ❑ Distari e to nearest lot line_---.-_ -_ — -•- --------- •---------------------- ------------------------------------ Remodeling ------------•---------------------f R emodelingnd/or rep icing (describe): 3 .- --•------------ -- ( .f / ------ ---------- ------------------ V ---- _ = .. v.z`- ----- '�----------- ----- ---•.- �..crk•----- �`..� - . .- ---,. ._ - a_ I here y certify that have prepared this application and that the work will be Awone in accordanot with San Joaquin County ordinances, State laws, anal rules and regulations of the San Joaquin Local Health District. (5i ned - - 9 )--- --- - -� --- ----- -- - •--- -------------------------� ---- -- ------ --------------------------------------------- --.(O ner and/or Contractor) BY: �I� � . 1 - - - --------------------------- ------ (Title} = --------- (Plot plan, showing size oflIiot, location of system in anon to wells, buildings, etc., can.be placed on reverse side). 4r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -------- ----- w --- DATE - - REVIEWED sYI�------------------------ ------ - --------- ------ --------- ------ DATE--------- ... BUILDING PERMIT ISSUEp------------- -- ----- - - -- ------------- ---- - ------------------- -•-•-- DATE----------------•------------- -------- -- Alterations and/or recommendations:--------------- .......... - ---------------------------------------I-------------•------- ---- --------------------------------------------- li --•------- --------------------------------- i -----------------------------------------•--------------------••---- --------•------------------------------ -- ------------ -------------------- ------------------------------------------- ----------------•----------•--- - -•------------ FINAL INSPECTION B' .._ S Date-- �� - r - --------------------- -- - �J ----------- 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 E5-9-2M 745446 ATW00D 12-54