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APPLICATION FOR SANITATION PERMIT PerN, 6. (Complete in Duplicate) ?� 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 OCATION -� �-------- E-! q-P-A_/- - ----------------------------------,------------------------------------------- �- '------------ Owner's Name - ----�= Tf--•------- - ----- -- - Phone- Address—------------(f hone. Address--------------+� ---------------------------------------------•------- -------------------------------------------------------•-...__._.-_...-----•-------------......-----•--------- Contractor's Name---- --------------------------------------------------------------- ------------------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _---7-'Number of baths ___I__ Lot size �_'V _ ______________________________ Water Supply: Public system [ 6mmunity system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam F] Clay.Loam ❑ Clay E] Adobe [Hardpan El � Previous Application Made: Yes ❑ No Ej-_-New Construction: Yes ❑ No ❑' TYPE OF INSTALLATION AND SPECIFICATIONS: V (No septic tank or cesspool permitted if.public sewer is available within 200.feet.) Septic Tank: Distance from nearest well_________________Distance from four)clat.io`n�_�----------------Material--------❑ �" ---.-_.----_______________._____-___--- of comp - -•artments-- - ------------------Size---------------- -----`--Li uid de- . ;q p,th------------------- -----.-:Capacity----------------------- Disposal Field: Distance from nearest well-___.....-__-.-_Distance from foun8ation______.___.______-Distance to nearest lot line_________________ ❑A:7 Xr w')0/cNumber of lines-------------------------- -------Length of each kine--'----------- -------------�--Width of french----------------------------------- Type of filter material-------------------------Depth of filter material----------------------- otal length_,___________._________________________._ Seepage Pit: Distance to nearest Distance from foundation_�b------.-- Distance to nearest lot line___---------- Number of pits.......,�__---------Lining material___-1LI Size: Diameter---�`� Deptrti__.._ _� Cesspool: Distance from nearest well----------------- from_foundation- _--_---________.Lining material---------------------_ ❑ Size:Diameter-------------------:------------- ----Depth------------------------------------------------=--_--Liquid Capacity-----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building._.--.--_-_.-_-___________..__.___..._. Distance to nearest lot line-------------------- -------- ------------ - a' 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, State laws, an8 rules and regulations of the San Joaquin Local Health District. (Signed)--- __. --------f/---- f---------- or Contractor] By:------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY----------------- c ---- DATE ' REVIEWEDBY j ------ - -------------------------------------------------------- DATE---------- -�------------------------------------ 1 �. BU]LDING PERMIT ISSUED --------- `C - - - DATE- ------------- = Alterations and/or recommendations:-------------------- ----------------------------- --------------------------------- `-------------------,------------- ------------- ----------------- ........----------------------•----•-----------•--•---•----••--••---------------------------------------------- i --- -------------------- --------------------------------- ------------------------------------------------ --------- ---- --------� �'- �----- --------- - f 5 F % I FINAL INSPECTION BY:. - ----------- Date. -- _ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streat 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Y' ES---9 145446 ATWOoo