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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) — Date Issued _ 1f - 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 LOC TION_4______2 /- •-.---_ -- -------- ------------------------------------------- ------ ----- -------------------•-- 4 Owner's Name------- Ph ------ ----- oned-a�:. � � .. . -------- Address-------------------------------- ------.r ---------------- -------_------- ,- ------------------------- - - ----------- ----- .. Contractor's Name. -------••------------ - Phone-//A--d"� 4 ------------------------------- -------- ----- ---- • ----------------- --•-•9----7. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Courf ❑ Motel ❑ Other ❑ Number of living units: __/---.Number of bedrooms :!7�_ Number of baths .Z.- Lot size Sa f.SQ --_ / ----------------------------- " -------------------- Water Supply; Public system �ommunity system ❑ Private ❑ Depth to Water Tables_ - ff. Character of soil to a depth of 3 feet:' Sand ❑ —Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made. Yes ❑ No [9----New Construction: Yes ❑ No Ujj_ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public.sewer is available within 200 feet.) r pti Tank: Distance from nearest well : F_- Distan `'f'rom foundation--------------------Material _ ------------------------ No. of compartments-- ----F-. -------------Size--------------------------------Liquid depth--------------------------Capacity----------- Djsuasal, Field: Distance from nearest 'Wolf---_____---------Distance.from foundation.--------------------Distance to nearest lot line___________.____ Number of lines----------------------------------Length of each line------ ----.-.Width of trench ----•-------------.----- Type or filter material-__c_}__,_.._.__:: _.-.(. _Depth of filter material`-------'.-.'---"..............Total length-------___..-_____ __ �! Seepage Pit: Distance to nearest well. �' Distance from f tlndation____ _ D�star�ye +o nearest lot line- -/4 Lam' Number of pits--------L.s__----_..Lining material___ _ _ Size: Diameter7_. -----------Dept h----- _ � Cesspool: Distance from nearest well------ _----------Distance from foundation....--------------..Lining material------_..__________.___________ ❑ Size: Diameter--'- ------------. -------- Depth--------------------•-------- ------Liquid Capacity----------------------------gals. �! Privy: Distance fromnearest"well_,____ ________________________._._.--------------------------------------------Distance from nearest building - ❑ -Distance to nearest lof line- ----------------------------- -------------------------------•-r ---------------------------------------------------- Remodeling and/or repairing (describe):________---______ F ' ----------------------_______•_•-t____...__.____------------------------- I I hereby certify that I have prepared this, application and that the.rwork will be done in accordance with San Joaquin County ordinances, S a e ws, and rules ai a ulations of the San Joaquin Local Health District. (Signed)--------- t : 1 - - - Owner and/or Contractor] By:---------------------------• = .. �. - (Title) - ------- -- - A (Plot plan, showing size of lot, location of system in relatioPeo—weils, buildings, etc., can be placed on reverse side)., FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ------------ ------------------------ DATE.-----7--.-t -------------------------------------------- --•-----------•----•----------------------- IEWED BY DATE �------------------------------------------- BUILDING PERMIT ISSUED _-_-_----------- --- DATE ---------------------------•----- Alterations and/or recommendations____----___________________ --------------------------------------- --- -••---------•------------- ---------• ---- - ` � .� ------------------------------ -------••----------- FINAL INSPECTION BY:.----- ------------_--- ------ Date--; SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 745446 ATWQOD 12-54