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APPLICATION FOR SANITATION PERMIT Pg,mit leo. ;_,?i4_.�__�, , (Complete in Duplicate) Date Issued _1411 G... 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 LOCATION----� - u-f� 1 Owner's Name---------------••-----••-�}UL....-------�e- --- -_ --------------------- Phone--------------------------- Address--------------...............-•----.........1-�y-f---/ -`---- ---`..Ee--��---------------------- Contractor's Name----- •--------------• I-,,- ----------------------------------------------------•--•--- Phone---------------------------------- ' Installation will serve: Residence g' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __..f_ Number of bedrooms --/-. Number of baths --_-__._ Lot size -----------7------------------- ._---.-_-_ l ��-�.. ( Water Supply: Public system ❑ Community system ❑ Private;E3, Depth to Water Table __rff. NIN, i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N( Hardpan Previous Application Made: Yes ❑ No� .New Construction: Yes E] No ( , TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) / z Septic Tank: Distance from nearest well---7-5........Distance from foun anon____________________Maters I --------- No. of connpartments--------2.--------------Size------fix-� - - Liquid depth------ -- -------- p y------ ----•- _.Ca acit Q Disposal Field: Distance from nearest well.....7 --.-Distance from foundation----_ZU.......Distance to nearest lot line---------------- - ` Number of lines--------------1__.___------ ----Length of each line-----------S0-- '-._.Width of french-----------p__fl=-��--__-••-- Type of filter material ✓Depth of filter material _.-.-_-.3�-._.--.Total length_______________________- ---__-. Seepage Pit: Distance to nearest well-------------------- from foundation------------------- Distance to nearest lot line__-__.--__--.._ ❑ Number of pits----------------------Lining material---------------- ---Size: Diameter----------------------Depth--------------------------------- Cesspool: Distance from nearest weil--------------- -,Distance from foundation------------------- Lining material--.--._-____---____._-_____---_-_--_. ❑ Size: Diameter-------------------- - -- Depth-----------------;---------------------------t----Liquid Capacity-------------=--------------gals. Privy: Distance from nearest well.................................................Distance from nearest building___-__-----_.._._____________.._____.___. ❑ Distance to nearest lot line--------------- ------------- ----------=--"------------------------------------------------------------•------•---------------------------- Remodelingand/or repairing (describe)--------------------------------------------------------------------------------------------------------------------------------------------------------- i -------------- ---- - - ------------------------------• ---•---------------------•-••-----------------------------------------------•---•---------•---•-----------------------------•-------------•--------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5ta laws, an rules and regulations of the San Joaquin Local Health District. (Signed)_./... ----AVLI---------------- 6_0 - -----(Owner and/or Contractor) By:. -----------------------------------------=------------------------ --_(Title)------------------------------------ --------------------------- (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.-----l-/�/ REVIEWED BY DATE ---A-4-------------------------- --------------------------------- BUILDING PERMIT ISSUED-------------------------- ----- -------------------------- - DATE. Alterations and/or recommendations:----------------------------------------------- --------------------------------------------------•--•------••----------------.-----•------------------------- -----------------------------•--------------------•------------------------------------------------------ --------------..,---------------- ----------------------------------•--•---- ----------------------------------- FINAL INSPECTION BY:------ -------- -- --------------------- Date-- ___:0. ..... --------------------------------------- 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 1 E" 9-2M 145446 ATWOOO 12-54 `