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+ APPLICATION FOR SANITATION PERMIT Permit No. -------------------- (Complete in Duplicate) s t Date Issued _ ----------- Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------1- '�'�5-------- /.� ' - Owner's Name----------/------ '------•-• :. -------- Phone Address'--....----- --•--: ------------- l-------------------------------- ------•- •-----------------------•----------------•-----•-------------------------------- Contractor's Name----- ------ --_ - -- --�-------------------------------------------------------- Phone-------•--------------------------- Installation will serve: Residences Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 Number of living units:/---- Number of bedrooms _.2--Number of baths .. _ Lot size ___fi__a___._ _./__ --------------------- Water Supply: Public system Dj_Community system ❑ Private ❑ Depth to Water Tabie .a.6 ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 0— New Construction: Yes ;�J, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank oricesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--_-_.-_---------__--___-___----___.____.__- -._. ❑ �f compartments- ---- -------------------Size------•-------------------------Liquid depth-_------------------------Capacity--------------------- Disposal --------- ----------- Disposal Field: Distance from nearest well._A-/-&,i,-LDistance from foundation___2.0_(..__Distance--to'nearest lot line----..Q_--'. Number of lines-------------f_.__ ��.------Length of each line___ ��_r__i,_�--_.Width of trench-----�.0- ---_-_-__-__- Type of filter material-___��:...__-5)QaDepth of filter material_-_.. - Total length___.__ . ________________________ -- Seepage Pit: Distance to nearest well.../.Vth-jL-Distance fr m foundation-__--,1_Q.-------Distance to nearest lot line----14.1_._. Number of pits----- ---------------Lining m �� aterial_____ LF_GSize: Diameter____.__. p -De th...... - �-------••-- Cesspool: Distance from nearest 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----------------------- G Remodelingand/or repairing (describe)---- ----------------------V--------------------------------••••-------------------------------••-------------------------------------•----------------- N •------------------------------•-----------•---------------------•-----•------•------------------------•-••---------------------------------------- - ---------•-------- r --- ---- -----------------•-----------•--------•---•----------------------------------•-•-------------------------------- ---- t I hereby certify that I have prepared this application and that the work will .be done in.accordance with San Joaquin Coun i ordinances, State laws, end rules and regulations of the San Joaquin Local Health District. (Signed)------u.. � ------- ------ ---------Owner and/or Contractor) -"By:- ----(Ttle)--------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on revere side). 4 FOR DEPARTMENT USE ONLY i --- --------------------------------------------------•---- DATE-----------•---- . ----- -- � APPLICATION ACCEPTED BY________________________ _____ _ _ � REVIEWED BY ----------._ DATE_ �..---- . yf -- --- DATE . BUILDING PERMIT ISSUED------------------------------------- ----- }�,� Alterations and/or recommendations:---------------------- - • ----------- -----='V-------- ------------- ---------------------- ------------ -•--- T` _ _ -- --- •----=------------------------------------- - P T •---------�-`-" -e"-r '...... ...........' _-:_1:T'"' -.R-s '- -i'Yari- ... --•----•-------------------- v ------ - -----a-- -T- A----- ----- ------------------------------------- ------------- INL 1= - : , r4 ---------------- F ,SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manfeca, California Tracy, California E$--'9--2M 145446 ATWOOP 12-54 t . t k11 1