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V • APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued .---_rte Applica-%n 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 AN OCATION.. l . U 11. -S o � -- !------ ------ - -- - - ------------ -- - ---------------------------- Owner's Name-------- --- . -- ----------------- ----------------- -------- -- ------ Phone. Address-----------v ------- -- -------- ---- ----------- 4 Contractor's Name------- = . ' r _.......... ----- 5--0-�---- ---------- . Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel a Other ❑ Number of living units: Q__ Number of bedrooms 4__ Number of baths _r?P__ Lot size j.------------------ Water Supply: Public system © Community system ❑ Private ❑ Depth to Water Table A e� ft. Character of soil to a depth of 3 feef: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Acloba4 Hardpan ❑ Previous Application Made: Yes ❑i No Dq New Construction: Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 i Septic Tank: Distance from nearest well---11/vN_e__Distance from,foundation-------IEO-------Material _._-C- -✓"`alt---------� ] No. of compartments-------� ------Size---------6 x-- q"- Liquid depth- Disposal Field: Di fS frow n'ares�-------__-_-Distance from foundation-------------____---Distance to nearest lot line,_-_____-______- [ ut44b r of i -----��-----------------------------Length of each line----------- ------------------Width of trench----------- ----------------------- Type of filter material-------------------------Depth of filter material __________-----------Total length___-:______-________--_____---______--._ Seepage Pit: Distance to nearest well------/V4N� -Distanc from foundation_-__- o_._.......Distance to nearest lot line_-____.-`_-_�___ UQ Number of pits._---15-----------Lining material_ Nk_214441e..Diameter._-__42.`� ---Depth-- --- ---------- Cesspool: Distance from nearest well-----------------Distance from foundation---------------__...Lining material__.__-..-_____.__-__-__-.-..__._.____ p� ❑ Size: Diameter----- ------------------------- -----Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------.__._____---------- 1 ❑ Distance to nearest lot line--- - - ---------------------------------------------------------- Remodeling and/or repairing (describe):--- -------------- -------- ------------------------------ - --- - --- ----- •-- ----------------------- ------------------------------- -- -------------------------------- ------------------------• ---•-------------------•----------------•-------------•---•------------••----------- ------------------.----------------------------------••------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State s, and rules and regulations of the San Joaquin Local Health District. (Signed)..----____ --- ----------------- --------- -----------:--------(Owner and/or Contractor) --------------------------------------------------------------------- $Y� 1'� ----- Tifle I �. - -R-------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1f' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ------------- ------------------------------------------------ DATE- / ` REVIEWED BY ----------------- ------------ --- - --------------------------------------- DATE-- ------ !-- BUILDINGPERMIT ISSUED-------------------------------------------------------------•----•--------------------------------- DATE------------------------- -- - - --- -- Alterations and/or recommendafions: --------------------- ----------------------------------••-------------------------- -------•--I----------•----- -------------•--------------------•---------I- ----------------------------- ----------------•--------------------------- -I ------------------------------ - ------------------------------------------•------------- ---------------•--------•-------------------------- _------------------ -- ------------•------- -------------------------------- 11Z_ ! FINAL INSPECTION BY: - ... -------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es�9-2M 145446 ATWo4" 12-.4 t