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Permit No. . APPLICATION FOR SANITATION PERMIT ----------� (Complete in Duplicate) Date Issued Applica+ion is hereby made to rthe San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ord- ante No. 54q JOB ADDRESSAND OCATION Owner's Name — . .�:-- " - •� =------ ----------""-"--------_ -_ Phone_ " + _. ---- - ----------- Address--- --- ----------- ----- - -- ------------ Contractor's Name___ __ _ !r -- ---•-•-• -------- -- f - -- _ � - 1� Phone ........ Installation will serve: Residence/ Apartment Hou ❑ Commercial ❑ Trailer Court ❑/ MoteR_1,5_6 Other ❑ Number of.living units: _f-___ Number of bedrooms J._ Number of baths __I___ Lot size __ ?_ .____ -_-_ f Water')u I Publics stem a. pp y: y D. Community system—E] Private Q Depth to Wafter Table ________ ft. .. Character of soil to a depth of-34AW_ Sand ❑ Gravel ❑' Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ �. YPE OF INSTALLATION AND SPECIFICATIONS: + (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt_`: Distan e fro f and Material_ � _� ``�-:�✓ow//� -/ sti -------------compartments ____---Size_ ________________ Li ui e th__---_-"'.--__.--:___-_-Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation____________----..Distance to nearest lot line__-____.._______- ❑ Number of lines------------------ ----------------Length of each line------------------------------Width ,'of french----------------------------------- Type of filter material______-_r'-.__._.__.*_'Depth of f-#ter material __---_-___----------Tofal "lerigfh "` _ ------------------_--------- Seepage _____ __Seepage Pit: Distance'to nearest well_.____------------Distance from foundation___________________Distance—to- nearest lot line----------------- Number of pits----------------------lining material-----------------......Size: Diameter----------------------- Depth_-_`f,=------------------------ Cesspool: Distance from nearest well__ _-----------Distance from foundation--------------------Lining material_-_--___--__--____-______________- ElSize: Diameter----------- --------------- ----------De th----------------------------- -------- -----Liquid-C--a citgals. Privy: Distance from nearest well_ _______________________________________________Distance from nearest building------------------------------------------ LA ❑ Distance to nearest lot line.'--- -- ------------------------- - -----------•--------•-----------------------------•------------ Remodeling and/or repairing (describe) ----------- - -----------------------------•--------------------------------------------------------- -- 1 --------------------------------------•------------------------------'-------•-------•------- ---------•---•-----••---------------------------------••----------------•---------••------- •------------------------------- -------------------------••-----------------------------------------------------•-•---•--------- ------------------------............ .--------------------•------------------------ ----------------------------------- ---------------------------------------------------------------------------•---•------ ---•-•-------------'--------------------•----------••---•---------------------------------•--------------------•-------------------- I hereby cer ' t t I have pared-this!application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and r les' d e ulat'ons of the San Joaquin Local Health District. d _-____-Owner and/or Contractor [Signe --- ----- --------------------• -----• - - - - - ------------ -- ---------- �----------------------------------------------- -------------- [ • rte. By: -- -------------------------------------------------------------------------(Title]-'O�--- :-:----- --------------------------- '-[ lot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). b . a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B - ----� ----------- - --------- --- -------=- -- --------------------------------------- DATE --------------------------------------------------- REVIEWED ,BY ------------ _ - bATE-: ' 6 UILDING PERMIT ISSUED - -------------------------------------------------------------------------- DATE-----•----Ls�--------------------------------••--•- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------- fes- ------------- n _ ._. _4--_ ..- - -- ------ ------------------- ----_- ----------------------------------------V..................... ----------- --------------- -- ------------------------------------------ --------- - -------- --------------------------------------------------------- - ------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------••------------------- FINAL INSPECTION BY:._-4! : --------------------------------------------- Date------------------------------ --._" - ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak $tree+ 132 Sycamore Street 814 North "C" Street Stockton, California ' Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATW09P 12-54