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APPLICATION FOR SANITATION. PERMIT Permit No. " -7.." (Complete in Duplicate) .4"�=It, - „�' Date Issued �W� 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 4L? CATION �4 - -6 , Owner's Name J.tiE_ k•- J --- = -------------------------------------------------- I ----• --------------------- --- ------ Phone-.--------••------------------••--- -------------- -------------- -------------------------- Contractor's Name------ U . -----••----••--------------------•---•----------------•----•--------------•-----•--- L --- ---• .---- ------ - Installation will serve: Residence KApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �---- Number of bedroomsr- Number of baths /... Lot size __- ---- Water Supply: Public system Communify system ❑ " Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ a Previous Application Made: Yes (] No 12�,-New Construction: Yes Gd No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: P (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-N,6-JV.W,-Disfance from foundation--.1-0------ ---.Material----r-��""�-�J.�?" No. of compartments P -D- -------- -----Size.SX)�:"X---•!`------Liquid depth-- -----�'-----------Ca acit Disposal Field: Distance from nearest well--4-4-/yp . +stance from faundatian._"./"�-"-_""--.pistance to nearest lot line."__.��__"" Number of lines----_-- -- ength of each line-----s�_"C1-""_"--- -- -__ Width of trench---- -- ---�_- """" Type of filter material _ �. _i_�, filter materia!"""_�-"� `j --•- Total length b- -------------- Seepage Pit; Distance to nearest well_""- --_---Distance from foundation--------------------Distance to nearest lot line----.":-._ ❑ Number of pits-------------_-----__Lining material---------------" -----_Size: Diameter------ F Deptn-- ----------- esspool: Distance from nearest-well_--"-_-."-_-".--_Distance from foundation------------------- Lining material--.---_._____-____ ❑ Size: Diameter.--------------- '-------- ------Depth------------------------------ .-.--------- Liquid Capacity --------------------------gals. Privy: Distance from nearest well------------------- --------""---_"""__""__".-Distance from nearest buildin ❑ Distance to nearest lot line`----------------- "---- g"' ------------- Remodeling and/or repairing (describe): �Q �' I------------------------------------------------------------- • - -------------------------------------- ----- ------ ----- - - -•-- - - -- ----------- --•--- ------ •----- - - - --- - --- - - -- - I 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 Contrac+or) By:.-------- - -----------------;-(---------------------------------------------(Title)------------------------------------------ ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed an reverse side). ° FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------_---_-- --- - DATE_ — ------------- EVIEWED BY -- - .................... BUILDING PERMIT ISSUED.--- ---------------------------- DATE----- -�--....- - ---------------•------------•-------------------------- DATE------ •-- - Altera+ions and/or recommenda+ions--------------- ------ r ------------------------------ �} ---•---•-------------- --- -------------------------------------------------------------- - 1% -------------------------- FiNAL INSPECTION - - --- -` ------------- Dafe.... - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lod;, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOb 12-54