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APPLICATION FOR SANITATION PERMIT Permit No. _.2a__l__?-. (Complete in Duplicate) /11 Date Issued ----------jl�__6.... 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 ith County Ordinance No. 549. JOB ADDRESS AN LOCATION_– s ' "�'-:� �� ------- ---_--`�``_-��r---�-------- �-------------------------- Owner's Name----------- _ c. .. ---• ------------ ---- - ._-:----- Pho -------------- ------------------------------------ Address - - --- -- - - Address----------------- C ,.'~ � _- 17------ Confracfor's Name------------------ ----------•--- -------- --------------------------------------------- - ------- --- - ------ Phone----------------------------------- Installation will serve: Residence Ap merit House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other I.. •, Number of living units: __/ Number of bedrooms _-�- Number of baths ---f-._ Lot size _- 61'------- --------------- �J Water Supply: Public system ❑ Community system ❑ 1}rivate�l Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clays❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No [ "� New Construction: Yes ❑ No e TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank o cesspool permitted if public sewer is available within 200 feet.) Septic Tank: st rf a from nearest well--,--------------Distance from foundation--------------------Material----__-___--.-.--.--------..-.----------__----- No. f compartmentsS e Liquid depth Capacity Disposal Field:s Distance from nearest wellAQ - sfiance from foundation- _-_----_- _.--Distance to nearest lot ine --------------- r n- umber of lines--------- -------- <-Length of each line--_ �f.Width of trench Type of filter material-�S..I- -Depth of filter mater;aL._..-_1_ ----....Total length--------- --- -_-__-._-___---- Seepage Pif: Distance to nearest weft----------------------Distance from foundation-------------------.Distance to nearest lot line----------------_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------...---Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining -t. - material___y._ --,---..9.--..-.--.---.---�---------. : Diameter------------------ -- Depth_ .Li uid Ca acit - _ 9a� ❑ . Size Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building-----------------------------------------. ! ❑ Distance fo nearest lof line----------------------------- -------------------------------------------------------- ---------------------------- -------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------ -----------------------------------------------------------------------------•- -------------------- ------ -- 1 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 and regulations of the San Joaquin Local Health District.. (Signed)_ - -- -------------_---� '------ ---------- ----------------------------------------------------------------------(Owner and/or Contractor) BY:-----------------------------------------------1/---------------�------------------------------------------------ (Title) - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE--------- ••------- REVIEWEDBY-------------------------_----------------- -- --------------------`- ` j.� . DATE-------� --� ---------------------- BUILDING PERMIT ISSUED------------------------- ------- -------------1_1--------- ------ DATE--------------------------- -------------------------------- Altera#ions and/or recommendations------- ------------------ ---fl,--.................................------------------------------------------------------•---••-- -------------------------- --------------------------------------------------------------------------------------------------I---------------------------------------------------------------------------------------------------------------- ----------------------------•--------------------------------------------------------------------------------.-....--------------------------------------------------------------------...-----------------------------------• --------------------- -----•-------- -- ------- -------------- --------- ------- --------- ------------------------------------------ --------- ----------- --- ----------------------------•-----....------ --------------------------------------------------------------- -•- ----- ----------------�—-------------------- --- ---- FINAL INSPECTION BY------------------- Date.- --------------------- ------�/-` 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 ES-9-2M 145446 ATWOOO 12-54