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'1 APPLICATION FOR SANITATION PERMIT Permit No. --__---'_�---....... (Complete in Duplicate) I` / Date Issued -_'_/___ -S4� Applica4-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. i JOS ADDRESS AND LOCATION____,_-7 �' Xj Owner's Name .Y---....._/Y. y ----------------------------------------- ------------- Phone-----____-----------•-----••--•-- . Address----•--------- Contractor's Name-------- ----------i--'k'/S� . /rf------------------------- - J-- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .___ Number of bedrooms ___ZiNumber of baths ----/_ Lot size -__ ____. -----7_r-________________________ Water Supply: Public system [Community system [❑ Private [ -'-bepth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑.Hardpan ❑ r Previous Application Made: Yes ❑ No [ New Construction: Yes ❑ No [J_ • TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: j . Distance from nearest well ______._.___Distance from foundation--------------------Material____.____.____________---_______________._____- ❑ i� -- 7No. of compartments--------------------------Size----------------------------.--.Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well__..............Distance from foundation____---________._..Distance to nearest lot line----------------- ❑ XIX;; OV Number of lines----------------------------- ---- Length of each line--------•---------------------Width of french----------------------------------- Type of filter ma e�ria A� ------__De th^-of filter-material-----------------------Total length------...--------------------------------- Seeps Pit: Distance to nearest well_,J�________ _-Distance om fou ation_____�C�_�___-Distance to nearest lot line-___�__. Number of pits----- f_.______Lining material _ 'W?K. ize: Diameter._ _��-_---___Depth_-___.�_j_ Cesspool: Distance from nearest well_________________ ' tante fr,,arri~found tion__________________.Lining materia--------------------------------------- El _.________,_.___._____-___________. y"• ❑ Size: Diameter---------------------------- ---------Depth-- -= --__-----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well___________________ ____________________________Distance from nearest building Distanceto nearest loft line------- ----------------------------•------------------------•---------------•-------------------------------------------------- . f / Remodeling and/or repairing {describe}: -------•---------------------------------•-------------------•------------ t •---------------------------••-----• -•----------------•---------------------------•--•----------------------------.._...._..-•------------------------------------------------------•-----------•----------------- 1 ------------ •--• ----------------------------------------------------------------------------------------- •------------------------------------------------------•----------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be.done in accordance with San Joaquin County ordinances, St ws, and rules and regulations of the San Joaquin Local Health District. _ F (Signed)- /S�f f V C r -••----•---... ------------ ----------------------•------------------------------------- (O er and/or Contractor) By:. - - ---- -- . -- ----(Title)-- ------------------------•---------- (Plot plan, showing size of lot, Iota ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY h- APPLICATION ACCEPTED BY----------------- DATE_.. _ REVIEWEDBY---------------------------------------------"---_>`�'__. ---------------------------------------------------- DATE------- - -------------------- BUILDING PERMIT ISSUED-------------_----------- C� ------------------------------------- - -------•------------- DATE----------�---------------- ---- and/or recommendations . `%, 7:-2------------------------------ Alterations - - ----------------- - -------•----•-- -_ - �r"`b' ---•---•--------------- �f --------------------------------5-- -------------------~f-------��-- -- - ---�------------- - - -- FINAL INSPECTION BY.-.-.- ---------_------------------- -� Date_:. S - --�- -------------------,------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street .814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWb00 12-54