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APPLICATION FOR SANITATION PERMIT Permit No. ...,7 .��..1--.... (Complete in Duplicate) \`fly Date Issued ---- ��/S--G 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 -�------5----- '�� ----------------------------------- Owner's Name------------------- ....'........... Address ,1 - .--- l'k �'�'.d--- -------- -----•------....----------------•--------•--- } Contractor's Name.............. :..... . L '' 's.`' c!' Phone................................... Installation will serve: Residence IS Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: �----- Number of bedrooms _ ._ Number,of baths /__-_ Lot size __-/ '74!� Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table .5.7. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2'bay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ® No E]-, 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__4 __-_-__Distance from foundation-.- --" �.-._____.Ma f) 'terial_j� /r3!:-G-------------------_ ® No. of compartments------ _--___---___._-Size__ _- ___ ,_ „__Y----5- ----Liquid depth------`>{--------- Capacity---- ...--- Disposal Field: Distance from nearest well.,S(,J.._-Y., .Distance from foundation. x!—:...Distance to nearest lot line.... _.__...... Number of lines_......... g _Length of each line_._. ..__.- ._ ___ .......Width of trench--- ` _�,_ ________________ e __ Len Type of filter material.. -_Depth of filter material---.. __°.,_._--___._._Total length.........!_ZZ®....................... 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---__-__._.._--------_-_--_.__-_--__-. f' ❑ Size: Diameter-------------------------------------Depth-----------------------•------------------- ........Liquid Capacity----------------------------gals. 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ' ;,5.�_r' rr' ------- -----------------------------------------------------------------------(Owner and/or Contractor) l � = By:--------•----------------------------------•----------------. ------------....... ---------------------------------------------(Ttle).......... ---------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT E ONLY APPLICATION ACCEPTED BY--...: .. _.. ..-_____--__ ._ DATE.... REVIEWEDBY----- --------_-------------------------------------------------- -------------------------------------------------------- DATE....................................................------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------ _--------------- DATE............................................................. Alterations and/or recommendations:------------------_------------ ---------- -- -----------------------------------------------------------------•-----•------------•-------------------------- -----.....•------••-------•-•--•---•-- ---------•--•-------------------------------•- -------------------............................................................... .................................... ---------- ---------------------------------------------------------- ----------------------------- ----------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: Date/1 /11_1- ?{----Z� ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOOO 12-54