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1 APPLICATION FOR SANITATION PERMIT Permit No. -_ _-------- (Complete ------(Complete in Duplicate) -1 A- Date Issued __________�_._____ _ Applicakion 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 o. 549. 4- 3 JOB ADDRESS A LOCATION . . ----- _ a/7 .----------------- ------ Phone------------- ------ Owner's Name--- =---- �,/ Address ' ar r•--, �J�.. . ---- ------------ ! ._.. Contractor's Name---- -- - -I ------- ��_'_------------ ---- Installation --- Phon .._�.7.� �2 Installation will serve: Residencertment House ❑ Commercial ❑ Trailer Court ❑ Motel F1 ' Other ❑ Number of living units: __ __ Number of bedrooms _F _ Number of baths _:: Lot size --- ----LLD---*--------___ Water Supply: Public system ] Community system ❑ Private �pth 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 ❑ No 1�_New Construction: Yes L=7�rao L� TYPE OF INSTALLATION ASND SPECIFICATIONS: (No septic tank or cesspool permitted if ubloc sewer is available within 200 feet.) x Septic Tank: Distance from nearest we ---- f om fo ndation__l _._____.Materi I___ �•— _- ______.�.__.______. No. of compartments..._._. Liquid depth__ _ -�------_--Ca acity--/.4--- n,nDisposal Field: Distance from earest welt- _�_Distance from foundation.-/©--r_.__.'Distance to nearest lot lined Number of ------` Length of each line________ Width of trench _�[_.____-- r �r-t�----- 9 . . ------- Type of filter material----/-A--__---Depth of filter material___..AT_ .-..Total length_-_-�_ __________________`.._ Seepage Pit: Distance to nearest,III---/.2� __Disfance om lfou dation___.. ._.__.Distance to nearest lot line----- Number of pits...... __ _________.Lining materia#__ --a�.._^.iDepth_; ' '__ �.-Size: Diameter-+ _ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------._______._.__-_. ❑ Size: Diameter-==----------------------------------Depth--------------------- -------------- --------------L:quid Capacity---------------------------•gals. \(, Privy: Distance from nearest well____________________ _ Distance from nearest building________________________________._ ❑ Distance.to nearest lot line-------- ------------------•-------- ---------•-----------------------•-------------------------------------------------------------------- Remodeling and/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 ate ws, an ules an regulations the San Joaquin Local Health District. k ' _ . Contractor}(Signed ......... .��''' - -- —---------------------------------- --------------(Title)---`--`„� '` (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 APPLICATIONACCEPTED BY.---- -------------••---•---------------- DATE-----�1-----------------------------•-••--------._._ f. REVIEWED BY----------------------------------- ----------------------------•------------ DATE---------•-- - - BUILDINGPERMIT ISSUED--------------------------------- --- -------- ---------------------------------------------- DATE.--------------------- �J ----- ----- Alterationsand/or recommendations:_ -------------------.... - -- -------------•-- --------------------------------------•---------------------•--1•--------------------------•-•- ----------•------------------- ------------•---------------- --------------------------------------------------------------- --- --------------- ------------------ ---------- ------------------------- ---------------------------- ----- ------------------------------ --------------•----------------•---------------•-••-----------....-----•-------•--------------------------•-- --------- ----------•--------------------------------------::---- -------- -----------------------------•-•------------------------------------------------- ---------------------------------------------------------- - / - Is� FINAL 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 ES-9-2M 145446 ATWLUD 12-54