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APPLICATION FOR SANITATION PERMIT Permit No. Z1_6�Z_4 [Complete in Duplicate) Date Issued ---0_ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This is application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND, LOCATION -- --- ------------------------------------ Owner's Name-------- t_Ce--- 41, ------ ------------- Phone-.----------------- Address------/�15�_/...... -------4G--W --- ------------- ----- I -_ -_ Contractor's Name----- ----- -`---- --53 -------------------------------------------------------------- Phone-- 1/yo_ Installation will serve: Residence Apartment House [-] Commercial E] Trailer Court El Motel El Other El Number of living units: Number of bedrooms ---- Number of baths ___%* Lot size ---------7-,_5--------?-<-------070---------------- Water Supply: Public system Commu-nity system El Private E] Depth to Water Table 47P ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E] Clay Loam 0 Clay E] Adobe & Hardpan Ej Previous Application Made- Yes 0 No K New Construction: Yes E] No k, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 'Septic Tank: Sfance. from nearest well_________________Distance from foundatio' n--------------------Material----------------------------------------------_ F-1 0/.,� compartments------- -------------Size------------------- ------------Liquid depth-------------- ------Capacity----------------------- Disposal Field: nce from nearest well._______________Distance from foundafion--------------------Distance to nearest lot line.-._.___________ El lines----------------------------------Length of each line------------------------------Width of trench ----------------------------------- Type filter material_________________________Depth of filter material---- ------------------lotal length___.___-_____.____________-___-._________i Seepage P47 Distance to nearest well--/\/ Distance from ff noatfi Distance to nearest lot line-- --_Zlo--- Number of pits------- ------ --- - Lining maferialC-- CD!amefer.------ Depth ---------- Cesspool: Distance from nearest well------------------Distance from foundation--------------------Lining material__.-_____________.._________________- N ❑ aterial-------------------------------------- El Size: Diameter-------------------------------:......Depth-----------__-------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well...............;._.________._.______._____-__.._Distance from nearest building_____'__--.__..__.____-_______..____.____. ❑ uilding------------------------------------------ F1 Distance to nearest lot line- -------r-------------------------------------------------------------- ----------- --------------:-------------------------- ---------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------- ----------- --------------- ..........-------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- __________________•_______.__-__________--_____________. --I...-----------------------k------------------------------------------------------------------------------------------------------------------------ I hereby ce * that I have prepared This application and that the work will be done in accordance with San Joaquin County 1 ordinances, S to la , and rules and regulations of the San Joaquin Local Health District. (Signed)---------------- - ----------- - ------ ----------- ----------------------------------------------------------------- ----(10 ner and/or Contractor) By:. —---ods[. --------------- --- -------------------------------(Title)----- _?f------------------------------------- (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-------------------------- ------ --- --- --------------- ------ ---------- --------------------------------------------- DATE BUILDING PERMIT ISSUED ---------------------------------------------------- DATE---------------------- ------------------------------------- -------- Alterations and/or recommendations:------------- ----------------- -------------------------------------------------------•---------------------`- f -----•------------------- IV ----------------------- --- - -------- --- ------- --- ------ -- -------- -- ----------------------------------------------------------------------1;x_1_1_1-------------------- livor ---------------- ---- - -- e--- ------ -- -------------- --- ------- --- ------------------------------------------------------------------------- ------------------- ------------------ ------ ------------------------------- ---------- ---- ---- -------------------------------------------- ------------------------------------------------------------------------------- ------------------------------------- ------- -- -------- ------------------------------------------------ -----------------------------------------• ----------------------------------------------------------- ---- FINAL INSPECTION --------------------- --------- Date------/--* �)_ -- sl - -------- ------------------------------------------------- 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 ATWCUD 12-5d