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APPLICATION FOR SANITATION PERMIT Permit No. _-- d..0.1_. (Complete in Duplicate) 9/ Date Issued .... Applica{ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance th County Ordinance No. 549. D A *6 2 �A �L�. JOB ADDRESS AND LOCATION-----=' x �=----- a---------------------------------------------------------------------------- Owner's Name :� --------.- Phone..lh!trr_ -�------------- Address............................................................. .•--.�`...`. . "�' -- ....................................... Contractor's Name .------V� ''�---------------------------------------------------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .----- Number of bedrooms .''Z-. Number of baths __l-_-- Lot size ..._` _x__I.7`_ ______________________________ Water Supply: Public system ❑ Community system,& Private ❑ Depth to Water Table 6_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 13 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No g TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__.5�------Distance from foundation ...f rial _.Mat _ No. of compartments.._....`. .. ._ ..__Size_.___.!z` - x_ ?___:___Liquid depth____ ------------------Capacity...... ©Q------ � Disposal Field: Distance from nearest well___. _b-__--Distance from foundation___i!0----------Distance to nearest lot line....'' Number of lines------------4i_-_.---_------ --Length of each line--------CA—5-----------Width of trench--_-.-.___'A_ `------------- Type of filter material-5 -c--- _ spth of filter material----------bf-------Total length----------------------------/01.- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits----------------------Lining material-..-_----.-__...__-._.Size: Diameter-----------------.-----Depth................................. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------_-----------------_--- 171 _.___.--_-_;.-----_.__.,---❑ Size: Diameter--------------------------------------Depth-------------------•------------- ------------------Liquid Capacity............................CSIs. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------.------ ❑ Distance to nearest lot line--------- --------------•---------------------------•---------------•--------------------------•---------•---•--------------•--------------- 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;' ate I ws, and rules and regulations of thaoSan Joaquin Local Health.District. (Signe = -- - -- - ---------------------------- -----------------------------------------(Owner Abdoer(Iledeea#or) By:----------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------------------------- ---------------- (Plot plan. showing site-of-lotr--IoEation of system in relation to wells, buikfings,-etc--can`be pfa�ett on re e e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------ --- -------------•----------------------------- DATE----------- ------- - - ................. tow REVIEWED BY DATE --•-----------------------------------•... BUILDINGPERMIT ISSUED-----------•------------------- ---------•------------.._.....--- ------------------ DATE.---------------------- ..................................... Alterationsand/or recommendations:----------------------------------- ------------------------------------------------------------------•-------------------------------------------------------- ------------------------------------------------------------------------------------------------------- --------------•--------------------------•---------...-------•-----•---------•--••---•--------------•---•------ --------------------------------------------------------------------------- --------- -- --------------------------•---••-------------------------------------------•--•--•-••-------------------------•--•---•-------•--- --------------------------------------------------------- ------ ------------- ------------------------------------------------------------- -------------------------------------------------------------------------- -------------------------------------------------- ---------------------- --- --- ----- --- ---------------•--------------------------------------------------------------------- -------------------------------•------ FINAL INSPECTION BY:. .. c_._-- - -- ..... .... Date----------------9.1--- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOO 12-54