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APPLICATION FOR SANITATION PERMIT Permit No. ......... t (Complete in Duplicate) Date Issued � _____ � Application 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 withCountyOrdinance No. 549. JOB ADDRESS AND OCATION..--------/_._r"_°C7 t------ 57t`t'C a -------- `/j r�J Owner's Name----------- - --d---- --ph------ .- .P70_0-t.�- -- - --�-- ------------------- -- --------..... Phone-----------------------•------•---- Address - -------�'�1 ��'!'t'r c. ------------------------------ ..................................... •------------•- -- -•-••---- l� Contractor's Name ` f"�'1.r .�/.. /1 I------------ Phone__/ . ._�-�---------------- Installation will serve: Residence :[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms /--_ Number of baths -/-- Lot size __ ________________________ Water Supply: Public system ❑ Community system ®'�Rrivate ❑ . Depth to Water Table S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ "Sandy'Loam ❑ Clay Loam ❑ Clay [►Adobe❑ Hardpan ❑ ''� Previous Application Made: Yes ❑ No @?r"'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 wellftPODistance from foundation___-1._......__.Material__----e—------. _. ! ---------- Ltd' No. of compartments._._._.cl---------------5izz_-`^G--- .-.---Liquid depth----- _d__ _.____._____Capacity---94- - Disposal Field: Distance from nearest well. /Distance from foundation___1d---------Distance to nearest lot line..s_.--_----- [ � Number of lines------------ ------._.______Length of each Iine__Ra. Width of trench----- ______-___.--____-_- Type of filter of filter material----/4r.*A---------Total length___.-44!___________________________ Seepage Pit: Distance to nearesf well___'_-.---------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material________.--____.---.---__--_________ ❑ Size: Diameter----- --r---------- Depth---------------=------------------------------------Liquid Capacity-------•-------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-_-_.-_.-----_._-_-___-_-_-----_---___ ❑ Distance to nearest lot line-----?------ ----- --•-------------- ------------............ __-------------- . , Remodeling and/or repairing (describe):--------------------------------------------------------- ----------------------------------•-------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ------ ---------------•-----------_._-----------•-------------------•--•--•-------------•-----__-_---•-••----•-----••-------•-----------------•----__.-------•--------------------------------------- I hereb certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- .------ -•----- ----------------------------- ---------------- --------•-------------(Owner and/or Contractor) BY-------------------------------R-at----------- ... ----• --------------------------{Title) ------•---•-------- -------- ------------------ (Plot plan, showing size of lot, location of system in :dation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- -- ------------- _- ----------------------------------------------. DATE-------f -----------------------------•-------•---- REVIEWEDBY------------------------------------ ------------------ ---- ----- ---------------------------------------- DATE---- ----- BUILDING PERMIT ISSUED------------------------------------------------- ----------------- --------------------------------_ DATE---- ----• ------ ----------- Alterations and/or recommendations---- ----------------------------- ----- - -••--•••--•------------------------------------------------------------ .. •-------------------------•--•---•-----------------•------------------------------ ----------------.---------- --------------------------------------------------------------•-------•- ------------------- -------------------------------------------------•----- -------- -------° -•---------------------------------------------------•-------•-•--•-•_----_-••---------•-••-•---------------------------------------- -----•---------------------•------•------ ------ --•---- -----------------------------------------------------•--------•••--------• -•------------•---------------------------------•-•-•-- ----••-•-------•---------------- -- -------- - ------- FINAL INSPECTIONBY:..- _ �----- --------------- Date_. --- J SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street f 6 Stockton, California Lodi, California Manteca, California Tracy, California i f Fs-9-2M 145446 ATWOOO 12-54