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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) //Date Issued � A a i described. Tglica-�ion is hereby made to the San Joaquin Local Health District for permit to construct and install the work here n 's application is made in compliance with County Ordinance No. 549. 0? 1 - �e-Z F;4--vN,17- 5 7- j-'d t JOB ADDRESS AND LOCATION——,------- --- -------X0 e -.... -------------------------- -e 2,4%— . 0 Owner's Name, ---- ---------� ---------------------- ------ ----------- Phone----- ------------------------------ ------------------------------------------------------------------- --------------- ---- --- --- Address------------- ...... Contractor's Name..----- - �--#--��-- ------- �-------------------------------------------------------------- Phone------------------------------- Installation will serve: Residence ga_.Apartment House [I Commercial F] Trailer Court C] Motel 0 Other ❑ Number of living units: ,/.____ Number of bedrooms .ig_ Number of baths Z---- Lot size -----9,0---- �- 16 ------------------------ Water Supply: Public sysfem C&-Community system El Private [-] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Ej , Gravel F Sandy Loam E] Clay_Loam [I Clay El Adobe Hardpan El Previous Application Made: Yes El No Dq New Construction: Yes 0- No ET TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wek-NV?,-�--- isfance from foundation--/1...........M ------ _______..Material-_-_-_ No. of compartments......5Z------------ Liquid clepth,.6- 6- ---------Capacity--------9'0-T-)- Disposal Field: Distance from nearest well_./1 'stance from foundation----- ...Distance to-nearest lot line----1j9-/ J� NuImber of lines------/------ ---...... Length of each line----- Width of trench -- Type of filter material/IF- _f Depth of filter material -- -----Total length___.__ ------------------- Seepage' Pit: Distance to nearest well---/Ve-11AC--Distance from foundation____- ------------Distance,)o nearest lot 19- Number of pits.__/-._____.______-/--------------- Lining material--R-cP.-v-Y<Size: Diameter.__- Depth..... -_-'_________- k Cesspool: Distance from nearest well-----------------Distance from foundation - -----------------Lining material------------------------------------- ElSize: Diameter---------------------------------------Depth---------------------------------------------- ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_____..._---.---_______________._______.. ❑ uilding------ --------------------------------- 0 'Distance to nearest lot line-------- ---------- ------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe):---------.----------------------- -------------------------------------------------------------------------------------- ------------------------------- -----------I------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------:-* --------------------------------------------------------- -------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State" I d rules and regulations of the San Joaquin Local Health District. (Signed ........ --- --- -------1----------------C:6;:��.� ----------------------------- - ---------------------(Owner and/or Contractor) --(.�--wg size of�Io� loc�a�fion o 41 --- r e. L49 By- -------------------------------- -------------------------------------- n reverse side). (Plot plan, s owing size" lot location of system in relatiorifo.w6lls, buildings, etc., can be placed FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------- -------------------- DATE v' REVIEWED ------------- ------------------------------------- BY--------------------------------- --------------------- ------------ ---------- - -------- ----- -------------------------------------------- --------- DATE-----------�?--------**-------------------*------------- BUILDING PERMIT ISSUED-------------------------------- --- --- --------------------------------------------------------- DATE -- ----------------------------------- Alterations and/or recommendations------------------- ------------------ ------------------------------------------------------------------ %;s------------------------------------ -- --------- --------- ---- - ----- ----------------- ----------- ----------- ------- --- ---------------- -------------------------- ----------------------- -- --------------- -------- --- - - --------------------- ------- ------------------------------------------------------------- ---------------I--------------------------------------------------------------------------- ----------- ------------------------------ ------------------------------------ ------------------- -------------------------------------------------------------- - FINAL INSPEC' TION BY: auDate = r ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 001 Street in Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWOCD X,