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3� y ' APPLICATION FOR SANITATION PERMIT Permit No. ____7_-z-..2_- (Complete in Duplicate) 3 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 County Ordinance No. 549, JOB ADDRESS AND OCATION-------- ------------ �•---- !jei?_ ----------------------••--------------- Owner's Name---------- ----'-------C_- ---•---------- ---------------- --- --------------------------------------- Phone------------------------------------ Address-------- -----------•----------------------.Address-------- -.1_3 � -- Contractor's Name � -------------¢------�'� 5 ------ ----------------------------------------------- -PhoneQ....4.-e�Q•�----- Installation will serve: Residence [3- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1--_ Number of bedrooms _.-�?rNumber of baths ---/--- Lot size Water Supply: Public system ®`Community system ❑ Private ❑ Depth to Water Table -/C-Oft. 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 ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--NU/i/tD.istance from foundation__R-,0._......M.ateriai__.(°Z.0 - J7 , �. No. of compartments-------- .------ size-----]'`�1�-- - -----Liquid depth_--- - __�o Capacity------ ''d-p-- i Disposal Field: Distance from nearest-welL.Arv-lq C kistance from --------- foundation. --_si6_.....Distance to nearest�lot--l�ine�-_ ® Number of lines___.__-___ Length of each line_______ ,.._.Width of trench------ Type or filter material--- 5IfrDepth -_-_�-- -------.-_------- - of filter material___-.f--�---___-.Total length----------- Pit: Distance to nearest well----------- --------Distance from foundation--------------------Distance to nearest lot line----- ----_.-_..-- ❑ Number of pits.....................Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- LCesspool: Distance fromnearest 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------ - ---- -------------- N ------------ Remodeling anld/or repairing fdescribe):----_<� ��c�? _-_p_ -------=ter .1 ------------- _- lr iI./-'------------------------------------------------------------------------------------------------------------------------------------ --------------------=---- ----- - -----------------------------•-----------------------------------------------------------------------•------------------------•------------------•--------------- ---•---------------------•------------------------ ------------------------------------------------------------------------------------------------------------I------------------------------------------------------------------------------------- -----------------------------------••-----------------------------------------------------------------------------•------------••---------------•-----------------------•----------------------•--------------------- -------------- -------- 1 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) --- ------ __. �---------- -� "-' - -'- g �--------7 -- -- -- - - - - (Owner and/or CantractorJ BY:_ ---.---- -- ----------------(Title)--- � r 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 APPLICATIONACCEPTED BY................... ---- ----- - -------- ----------------------------------------------- DATE------1'1— ----------------------•- - - ---------------- REVIEWEDBY---- ----------------------------------- ---- ---- -------- - ------------- --------------------------- -------------- DATE--.-.- ----- BUILDING PERMIT ISSUED---------------------- ----- --- ----------------------- DATE..------- - Alterations and/or recommendations:----------------- - ---------------------------------------------------------•-------------•---... Jo -----------------•-------- ---------- ----------------------------------------------------- ---- --------------------------------------- -------------------------------------------------------------•-------••----------------------•------•-.------ ------------- ----------------------------------- -- ----------------------- ---------- - ------ ---------------------------------..--....--------------------------•-------------------------------•------•- t - --------------------------------------------------------------------- FINAL -------------------------------------FINAL INSPECTION BY:.___..c _ Date .... ..'._._Z`:. . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street [32 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-5-2,.4 145446 ATW000 12-54 e'