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No. . APPLICATION FOR SANITATION PERMIT Perm.+ _.. z. . (Complete in Duplicate) 1/ s— 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. JOB ADDRESS AND LOCATION--------------- -- l_ ---_ _ --. --- ........................ Owner's Name--•-----•------------11" -••------ - -- ------------ ---- -r 0.• Phonej _°_ c �-7 Address---------------- ---a----- <p" ^ - -- -------- ------------ Contractor's Name------------�'7-' s -•--••--••--------------------•------------------------------ --------------------•-------------•-------- Phone----------------------------------- Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: _I.___ Number of bedrooms ',Z--Number of baths ./___ Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet:s Sand Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe 21-14ardpan ❑ Previous Application Made: Yes ❑ No 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 well_)��+•4,___Distance from foundation__/-?...........Matefial_ Z'`" _`L+ '� ___.____ . p --- _ _.,. uid depth- '!--!r----------Capacity-----0 No. of com artments______�______________Size_�� .__ _ .Liq Disposal Field: Distance from nearest well. Distance from foundation_1rC_----------Distance to nearest lot line-_S__.1_______ Number of lines____________________________ ------Length of each line--------- ' f Width of trench------._-_____.______..____________ Type of filter ma Depth of filter material .____. Total length___.__ __ _Q____________._. --------- Seepage Pit: Distance to nearest well______----_-----------Distance from foundation-------------------Distance to nearest lot line----------------- ❑ Number of pits---':_.----------------Lining material-----------------------Size: Diameter----.------------------Depth-----------------•--------------- Cesspool:' -------- ----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 lire----------------------------- ------" ----------------------------------•------------------------------------------------------------ Remodeling and/or repairing (describe):--------------------- --------------- ---------------------------------------•--------------------------------------------------•• �3 --------------------------------------- -------------------------------------------------•--•-----•--•---------...------•-•-.• ---------------------------------------------------•---------------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)Y� 1 - =-------(Owner and/or Contractor) ---------------- ---- ---- '2-------------- - ----------------------------------------(Title)------------------------------------------- - - ---------- ---- (Plot plan, showing size of lot, location of system in relation to w Ils, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ------ --------- --------- ------------------------------------------- DATE j -------------- r------ REVIEWED BY----------------- ------- ----- -----=-- - DATE--- __ BUILDING PERMIT ISSUED ------. ------- - -• - ------------------- DATE.------------- -------------------------------- Alterations and/or recommendations:------- --------------------------- ----------- ----------------------------------------------------•---------••----•------- ... -------------------- -------------------•---------------•----------•--------•-------------------- -------------------------------------------------------------------------------•-----•-••• --------------------------------------- ........... ---------------- -------- ---------- ------- -------------------�---------------------------------------------------------- ------•-----------------------------------------------------------------------------•.---...__ FINAL INSPECTION BY: ----------------�--------------- ------------ bate - -• -- �(y SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 01.4 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOP 12.54