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:I E r — APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. �_�.✓�,<-_ (Complete in Duplicate) � 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. /L itiJ ZSS- (O�- C) JOB ADDRESS AND LOCATION________ / I- ---- ----- ---- Owner's Name__/1�__ - y ----- ---- ----- ---- -- Address----- -- --- ------- Phone ---- -----••-�-------•---- --_-•-•---1.9�------------------ -------------•-------------- • �r '� -------------• --------------------------------------•----------•- Contractor's Name.__> ,_ _.. Installation will serve: Residencef Apartment House J] Commercial ElTrailer Court ❑ Motel ElOther E] Number of living units: _L____ Number of bedrooms r Number of baths _�__� Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table __ S_ ft. Character of soil to a depth of 3 feet: Sand p Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Jj Hardpan ❑ Previous Application Made: Yes ❑ No V .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 we�i /_ �=`- Distance from foundation_ �' atria l -- Liquid�l th___._ Capacity_.__No. of compartments--------- -¢Q- Disposal Field: Distance from nearest well.- Dstance from foundation s- . f _!________.Distance to nearest lot I;ne__--,OA' •_ Number of lines--------------- g0 _ Width of french__.___ _ ��_,---_.----_---- --;*----__ Length of each line______________ Type or filter material-_____'3________________Depth of filter material___._-/.�-------.-Total length------------� t --------------------- Seepage Pit: Distance to nearest well----�16-----_---Distance from foundation___-•6_�.__-_-Distance to nearest lot line----t6! ( Number of pits-------- ------------Lining material--------- -— Size; Diameter__. 5.3------- ---De fin-_----v? - � p T---------------•--- Cesspool; Distance from nearest well_________________Distance from foundation___._.____._._..... Lining material__._____.._.__.._____-___ ❑ _ Size:_,Diameter. -------------------- '-------Depth-- ------7!:,._ --------------- --=� Liquicl-Capacif ' " . - �= �----•-------------- -----gals .,: Privy: Distance from nearest well________________________________________ -Distance from nearest building ❑ Distance to nearest lot line_________________________________________ Remodeling and/or repairing (describe)_________________________ _ -------------------- •--•-•-----•-----••-•-------------------------•----•---------------------------------- -----•------•--------------------- ------------------------------- - --------------------------- --------------------•--------------------------------------- -------------•---------------------------•-------•-----------------------------------------------•----------------------- (r I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and rules and regulations of the San Joaquin Local Health District. �~ (Signed) ---- -------- � ---- ----- Owner and/or Contractor) _.. ... _. . -By:--- ---------- - 6IT ! � � .,,,� - - -------------------------------------------------- it e)---- ___ (Plo+ pian, showing size of lot,'Iacation of sys+em�inrelation to wells;buildings, etc., cane- ane placed on'ree�sside).- - Y - _ -- .. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. J DATE- REVIEWED - -------- --- ------ ------ -------------- •------------- - ^ REVIEWEDBY_. ---- --- ------- ------------ ----------------------------•----------------------------- DATE.___t - ---------- PERMIT ISSUED--------_------ ----- BUILDING - ----- DATE Alterations and/or recommendations__________________________________ __ � ---`----------•------• - ---•----------------•------------------ ------------------------------------------ --------- FINAL INSPECTION BY---------------- ---- �� r Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWODO 12.54