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APPLICATION FOR SANITATION PERMIT Permit No. ---7;z.-/-/...... (Complete in Duplicate) Date Issued --_ �-40- 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 LOCAT N___-�----C /-- '- X------- - Phone.- ---------------------------- Owner's ---------------------------Owner s Na`me-_.�� ..----- - -•-• - ------ -. - -------------- Address__. D.,----.. F'....__ ----------------------------------------------------------- .4-0 ... ... ------- Contractor's Name -----•-------------------------------------------------------------------- - Phone Installation will serve: Residence Apar+ment House [ICommercial ❑ Trailer Court [I Motel ❑ Other ❑ ` Number of living units: .-f--_- Number of bedrooms ,�_ Number of baths _ ---- tot size -- --- --/- a------------------ Water Supply: Public system 4,_<0mmunity system ❑ Private ❑ Depth to Water Table tiJ 9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam Ll Clay ❑ Adobe ardpan El Previous Application Made: Yes E] -No w Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e c k: Distance from nearest well ....- ----_Distance from foundation--------------------Material_------- .---_--- n,_ - :, � 7,= �� No. of compartments....----------- --------Size------••--------- Liquid depth. - Capacity;,,_Tr-.------": _ , Dispose field: Distance from nearest well... ..-_.-Distance from foundation--------------------Distance to nearest lut,line== `_ _: ;. Number of lines r - -- ell. Length of each line. Width of ranch.-. "; -_ ` Type of filter material--------------- -------Depth of filter material-----------------------Total length------; - -----------------------•- ` Seepage Pit: Distance to nearest well- ----DistayTce rom fo nda ion_._-f_ -�--•Distancetonearest lot line_-/(.'_--- Number of pits-_---/----__.-.----Lining m anal;-__- -- . ae: Diameter ------------------ fou - .. .Depth-- r \ Cesspool: Distance from nearest well-------------- --Dista m foundation._._-.- Lining material__..--....__-.-.-_..--.--__------_--- ❑ Size: Diameter--------- ----------- ---------- -- e th-------------- ---------- Liquid Capacity----------------------------gals. \ Privy: Distance from nearest we1l---------------------------------------- --------Distance from nearest building----------- Privy- ------------- = Distance to nearest lot line---------------- ---------------------- -----------------_-------------------- ^ r Remodeling and/or repairing (describe}:----------------------------------------- --------------------••------ --------------------------•--•--•-----_--------------------------- ---------------------- ------------------------•---------------------------------------------------------------------------------------•---••--------------•----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinancogrule and regulations of the San Joaquin Local Health District. Contractor] Si ned { g - By:. Title ------------------------------------------------------ Y. plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE - --- ------------------------ APPLICATION ACCEPTED BY------------- -- ------- - -- _ ----------------------------------•-------------- -- REVIEWED BY - --------- - -- -- ----- ----- DATE BUILDINGPERMIT ISSUED------------------------------- ---- ------------------------------------- DATE---------- `- -------------------------------- -------- ---------------------------- Alterations and/or recommendations: - -------- ------ -------•------ - ' v - - ------- ----- --•---- ------------------------------ r - ------•---•--------- •--------4 ---------------------------------- -- ------------------------- ------------- ------------------------ -------------------y- -------------------- --------------I ------------ ------------------------- - ---------- -----------•-------- ----- r ----------------------------------------------------------- ------ ---------- - -- ---- FINAL INSPECTION BY:-._-.-. - __ .5----------------- ------------ Date------ ------ - -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street l30 South American Street Trac California Stockton, California Lodi. California Manteca, California Y, ES-9-2M 145446 ATWOOO i2-54