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APPLICATION FOR SANITATION PERMIT Permit No. 3 5-----, (Complete in Duplicate) ! 7 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. n �. ai JOB ADDRESS AND LOCATION_ /1 4- - ----- --- ---1-------------- -------------- tit ------ ----------- Owner's Name----------- 1 r'' -- --------------------------------------- ------------------------------------ -- -- - ----------------------- --------.. Phone--------------- -------------------- Address. .� i =1 .._cl-'1' - ----------- -----------------------------• Contractor's Name-------------f-:� '1--'-----------------•- ---- --------------------------------------- ---- - ---------------------------•-------- Phone----------------------------------- Installation will serve: Residence I i Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other E]__! Number of living units: ----- Number of bedrooms ___'Number of baths __ ----- Lot size ___.7Q___�_�'0h-�'�J Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑, Adobe Hardpan ❑ Previous Application Made: Yes E] No 04 New Construction: Yes E] No , TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: — Distance from-nearest.-well_--------------Distance from.foundation_______- _-----___,Material_________--_.___---..------____-_. ----- -----Size--------------------------------Liquid depth---------- ----- --- ----Capacity--------------------- ❑ No. of compartments-------------------------- - Disposal Field: Distance from nearest well----------------Distance from foundation--------------------Distance to nearest lot line___________-____. ❑ Number of lines-----------------------------------Length of each line-----------------------.------.Width of trench.---------------------------------- Type of filter material-------------------------Depth of filter material-______________I------Total length------------------------------------------ Seepage _______.._________________________---__-_ See a e Pit: Distance to nearest well_b_o�__ -._._!_Distance from founds ion___ �_�---------- to nearest lot line_____________ �g Number of pits.------I-------------Lin'ng material *_X..4._.Depth-------�------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_._._.-------_.----Lining material____--._.___--------.______.________.. Size: Diameter--------------------------- -----------Depth----------------- ------------ --------------------Liquid.Capacity -------•-------------•-- Privy: Distance from nearest well---_--------------------___----------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- ------- --------------------------------------------------- ------------------------------------------- --------------------------- Remodelingand/or repairing (describe):------------------------------------------------•--------------------------------------- -------------------------------------•----------------------- ----------- -•--------•-------- ----------------------------------------------------------•-------------------...--------•--------------------------------------•----------•---------------------•-----------------------•--- -- ---------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a laws, and rules and regulations of the San Joaquin Local Health District. --------Owner and/or Contractor By: 1... ---------------------------------------- ---------(Title)---------------------------------------------------------- (Plot.plan, showing size of lot,,location of system in relation to.w61Is,_build ings, etc., can be placed_on reverse side]. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- --- -------------- -7_;7)- •------------------------ DATE---- --------------------------------------------------- REVIEWEDBY------------------------------------------- ---- -- r �e ----------------------------- DATEc,�`�----- ------------ BUILDINGPERMIT ISSUED------------------------------- ------- --------------------------------------------------------- DATE--------------------•------ --------------------------------- Alterationsand/or recommendations:------- -------------------------------------------------••------------•--•------------------------•--•----------------------------•-•----••----••------------- -------------------- -----------------------•- ---------------------------------------- - - ------•----- FINAL INSPECTION BY: �3 ^-s' Date------ ------'� ------ -------------------------------- 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 E5-9-2M 145446 ATW000 12-54