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APPLICATION FOR SANITATION PERMIT Permit No. ..� --- (Complete in Duplicate) S Date Issued ._..- - 11I-'-- -!,�O /2 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. 1: Le U6C T y -,C 7- , W C JOB ADDRESS AN LOC TION_ --fit .. - '._. ------ -------------- tl---------------------------------- Owner's Name.-- - -�._ ---------- - Phone. Address + 1_ �� • -------------------------------•--------------------------••---- Contractor's Name-------------- -- --- - �1'.e 'k4 's`✓ ---------- --- -- Phone Insfallation will serve: Residence ❑ Apartment House ❑ Commercial (E-'T-railer Court ❑ Motel ❑ Other ❑ Number of living units: __----Number of bedrooms -_ Number of baths.. Lot size ------------------------____________________________________ Water Supply: Public system ❑ Community system ❑ Private' Depth to Water Table .--7 ft� Character of soil to a depth of 3 feet: Sand ❑ Gravel ] Sandy Loam ❑ Clay Loam [I ClayAdobe Hardpan E] Previous Application Made: Yes ❑ No k� New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 f/Wt.) Septic Tank: Distance from nearest well__100+Dist c f u �letion_ _. ir er al___________________________ v sF� _- - �a No. of compartments-------Z ------------Size _44-A---8-X..ar-.__ iquid depth- a-�- Capacity $�10�0 S i4 X�� x� ��' -------------- Disposal Field: Distance from nearest well___.�0____Dist nc from oun anon__.................D st n e fio nearest lot li �► �. Number of lines--------,.��- --- --------- ---Length of each line_/��-lP ---. Width of trench/.--- - ---------- t) OK Type of filter material___ ��-Depth of filter material__-1. --u._ Total length___.(rj- 0 -------- t. Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance / t� ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth_7f -------------------- i Cesspool: Distance from nearest well-________________Distance from foundation-------------------Lining material------------------------------------- [� Size: Diameter---- ------------ -------------------Depth----- ...:..-----------------------------r----------Liquid Capacity..--_ ---------------------gals (� , Privy: Distance from nearest well .............._•_.___--________._.---__.__._Distance from nearest building_------.-------------------------- C ❑ Distance to nearest lot line_--- ----------------- --------------------------------------------------- ------------------------•------ ---r------------------------ Remodeii and/..o r rep firing (describe):_ _______ ___ __ ____ ....I ►- 1.�-••- •-- � "'f ------------------------------------------I-------- ----•------- . ----------------- --------------- -------------------------------- --------------------------------------- -------•----------------•--------•------------------------------------------------------ --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a rul and regulations of the San Joaquin Local Health District. 5i ned --- - -------------- --------------------------------------------------------- ---- - (Owner and/or Contractor] ( 9 )-- 7� By:__-------- Tale --- - - - - --- (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--------------------------------------------------------- - - - - REVIEWEDBY--------------------------------------- ------------ ------------- ----------------------------- DATE--------------------__------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------ --------•---------•----------------------------------- -- DATE ( =- •---------------------------------------------- Alterations and/or recommendations:------------------------------ ---------------- -------•--•-------------------i y�v------------------ ---------•-- -••------------- ------------------------------------------------------------------------------------------------- a s� ± ------------------------------------- ---------------------------------------------------------------------------- ---------------- b ----------------------- -------------------- -------------------------------- ------------- INAL INSPECTION BY:.------- - ---- - - -------------- 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 145446 ATwooa