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g APPLICATION FOR SANITATION PERMIT Permit No. ..... �ft._ .. C 4 _ l 1 (Complete in Duplicate)Y Date 15sued _�!_13��. 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 Ordinan a No. 549. JOB ADDRESS AND LOC ------..4 Owner's Name----...----- -- .! ��4 - -- Phone-&-.Z401-0-------------- ----------------------- ---------------------------------------- Address--------------------.... ' ` Q----6.•--•----------- ......------•--------------•-------------------•---------------------...------------........................7--------------------------------- Contractor's Name................vke�o....... TSS.'-------------------------------------------------- - .......................... Phone-*...11.2.- Installation will serve: Residence' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ... Number of bedrooms ---A. Number of baths __/... Lot size ...... Xl _ o ---------------------------------- Water Supply: Public system ❑ Community system` Private ❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(M Hardpan ❑ k3 Previous Application Made: Yes ❑ No % New Construction: Yes 0 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 well-----------------Distance from foundation__-_..-_--_-_____--.Material_-._---_-.-_._--____-_.----------------------- "k, EXpw-7 No. of compartments-.---__---------------Size--------------------------------Liquid depth--------------------------Capacity--_------------------ Disposal Field: Distance from nearest well._.... ----------,Distance from foundation--------------------Distance to nearest lot line................. tvR107 Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material---------__________/__ _Depth of filter material_--_.--_.___,_�_C_____.Total length---......_.._.__..._.._.._...._.._.._d... . Seepage Pit: Distance to nearest well------- _ W—Distance from oundationAy'.........Distance to nearest I „f Number of pits.....1--------------Lining material --------Size: Diameter-----1.X1.0p ---------De to--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------..._--__-____._. ❑ Size: Diameter---__-------------------_--------Depth----------------------------- ----------------------Liquid Capacity.............................gals. Privy: Distance from nearest well-.----------------------------------------------- from nearest building------------------------------------------ ElDistance to nearest lot line-------- ----------------------------------------•------------------------------------------------------------------------....------•-------- ,gip .w y Remodeling and/or repairing (describe):---- _ t �.. ----------------•------------------------------------- -------•----------------------•--------••----------...........................................................................-----------------------------------------------------------•---._..-------------------------- •---------------------------------------------•-----------••----------------•-----------------------------------------------------•---------------------------------------------------•------- -•------------••------•---- ----------------------------------------------------------------------------------- •-----------------------------------------------------------•----------- ---------------------------------------•---------------.----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat e la s, and rules and regulations of the San Joaquin Local Health District. --- --------- ----------- ------ ------ ---- --------- ----- Owner and/or Contractor (Signed) ( / ) --- By:......................... '' .......................................................(Title)--------------------------- (Plot plan, showing size of lot, locati n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ---------- ---------- :---------- -------------------------------------•----- DATE--------�--------------------------------------------- REVIEWEDBY---------------------------------------------- ---------------------------_-_---`-------------------------_ DATE-----------__-n .f/ _ BUILDING PERMIT ISSUED------------ ----- --- - --------------------------------------------- --------- DATE------------------ _� -------------------- Alterations and/or recommendations--------------------------- ---- ----- ----------------•--•-•------------------•----•-•--•----------•---•-----------.... •----------- � --------------•--------------------- -------- ....... - - ----- --- ------ - ---•-------- ------------------- S ------------------------------ -------------------------------------------- -------- -------------- ----------------------------- --------------- ----- --------------------------------------•--------------------------- -------------------------------------------------------------........ FINAL INSPECTION BY:.. ... Date --------------- 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