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`cr APPLICATION FOR SANITATION PERMIT Permit No. !'- (Complete in Duplicate) 2- ^} N\ Date Issued ___ A 1_______ 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. 544.C- JOB ADDRESS AND LOCAT N 3 2--- t/1/--.- L s ------•-- --------------------------------- Owner's Name '"_" .. 4' �. ----------------------------------------------- Phone-------------------------------- Owner's � ----------- Contractor's Name...-------•------------•------------------------------------------------------------------------ --------------------------------------------- Phone----------------------------------- Installation will serve: Residence M--`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: Number of bedrooms --;?.—. Number of baths I--_ Lot size /�a �- -- ---------------------- Water Supply: Public system ❑ Community system E] Private R?'16'epth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ®'t lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No 6v New Construction: Yes [?"'INo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: u (No septic tank or cesspool permitted if public sewer is available within 200 feet) Septic_ nk;__ _Distance from:nearest weL_,:T10_'_._-Distance from l� tY___________-_•__ _ __________ No. of compartments...-___ __-.� de h .. 7 _-_-.__._Ca aci Disposal Field: Distance from nearest well--�,?�4'M--Distance from foundation P. Distance to nearest lot line---_ Number of lines_-----_.$_.__ ___ Length of each line__3S'f ;_1d. Width of trench-._�_`/-�+.................. Type or' filter material___$0 Depth of filter material____/_ '�-___-.Total length-__------ A-I______________________ ' Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_.__.____-.____- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.............----------Dep th-----------_-------.------------- Cesspool: Distance from nearest well-----------------Distance from foundation___------__.------ Lining material--..____._.___---_-------_._________ Q ❑ Size: Diameter--------------------------------------Depth---------------------------------- ---------- ----liquid Capacity----------------------------gals. Privy: Distance from nearest-well-------------------------------------------------Distance from nearest building------------------------------------------ El Distance to nearest lot line----- ------------ ------------ -------------------------------------------------------------------------------------------------- Remodeling -------------------------------------- -Remodeling and/or repairing (describe):-------- ------------ ---------------------------------------•--------------•------------------------------------------------------- 4 ------------------ ------- ----------------------------••------------------------------------------------------ -----------------------------------------••----------------------------------------•---------------------------------- -----------------•------••------------------------•------------------------------•-------------------------------------------------------------..__...------••-------------------------------------•------------•--•--------- ------------------------------------------ -------•-------------------------------------------------- ------••-----.---•--•---------•----------------•---------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laves, and ruleand regulations of the San Joaquin Local Health District. (Signed).----..-.� - . ��Ct:-��,,��--------------------------------------------------(Owner and/or Contractor) _ By:----------------�----------------------------------------------------------------- ------------------------------------------------(Title)------------------------------ -------------------------------- (Plot pian, show /size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEP-A,RTMENT USE ONLY -- APPLICATION ACCEPTED BY -... ... � - _-------- DATE---- -4;�-----. ... REVIEWEDBY-------------------------- ------ ---------- -------------- ----------------------------------------------- DATE--------------------- •------•---------------------------- BUILDINGPERMIT ISSUED---------------------------------- --------------------- -----•--------------------------------------- DATE------------------------------------------------------------- Alferaflonsand/or recommendations--------------------- ---------------------- ----------•-----------------------------------------------------------------=-•_...------------------------------ ----------------------------------------------------------------------------- ----------- ---------- ----------------------•-------------------•------------------------------------------------------•---------......... ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------- ------------^--------------------------------------------------------------- ---- -----------�------------------------------------------ FINAL INSPECTION BY: r Date 1----r---------------- -------------------------------- � r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street 4 Stockton, California Lodi, California Manteca, California Tracy, California ESQ-9�2M ^145446 ATWCOP 72-54