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APPLICATION FOR SANITATION PERMIT Permit o. __-. d'l.�------ (Complete in Duplicate) -. Date Issued 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 9 County Ordinance No. 5/49. / JOB ADDRESS AND OCATION...____/---v-�_' ______________�---©------------------- �/ Owner's Name-.--.-- -• ------ ---`--=-•D----------------------------------------- ---------------------------- ------ Phone------------ Address--------101A!----------_45.10. Contractor's Name----- --�-------`-"-1 — -"^-.----- ------------------------------------------------------ Phone �f Installation will serve: Residence ®.Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: f----_ Number of bedrooms ---1--- Number of baths --- Lot size -------�:?(---4-8____ Water Supply: Public system R Community system ❑ Private ❑ Depth to Water Table =3�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 �0_ No ❑ 'f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we1L.-M?-V--Distance from foundation-----Id-._-_.Material--._--�G-� -_-----. ® � No. of compartments-------- -------° Size-- ---Liquid depth EQ �9,14 �/ r Disposal Field: Distance from nearest well-../Ylhc!,!,Distance from foundation----1�?D........Distance to nearest lot line----2D• l 5A-. Number of lines---------- -------,---_ __ Length of each line--- 1- - --�--Width of trench---------�`�- ------------ Type of filter material--- --- �S.)'?,Depth of filter material-..----A--------Total length-=-------'�,<�--�--- --------------- Seepage!Pif: Distance to nearest well--_1+f ,c Distance from foundation--- --4.).-_.-..Distancg to nearest lot line.--_ `__ .� Number of pits---------1------------Lining material---C-�-14<t+ 3`rze: Diameter__-- _.J' ' `f -- Deptn------94--=5- -•------ 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------------------- ------ -------------------------------------------------------------------- Remodeling ------------------ --•------------------------•----------------- Remodeling and/or repairing (describe):-------- ---------------------------- -------------•-------------• ----------- ----------------------•---•------------•----------•-•-----------------•-•------------------------------------------------------ -----------------•-------------------------------- I hereby cert_that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aid rule's and regulations of the San Joaquin,Local Health District. (Signed) % � = = ----------------------------------------(O7wner and/or Contractor) $Y:•-- ---- ;'"---zy --- -- ---------•----------(Title)--- t (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 •-------••----------- REVl1 WED BY ------------------------------------------------ DATE------- •. ------------------------------------------ BUILDING PERMIT ISSUED--------------------------------- L Alterations and/or recommendations:--------------------- - _?- _ , _ - 1 . --------------•- ---------------------------------------------- FINAL INSPECTION BY:..-.--.. ----•- ---------- ------ Date...... L - 0 Y ((•• ---------�-'°------------------------------------- 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-g-2M 145446 ATWOMD 12-54