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� D APPLICATION FOR SANITATION PERMIT Permit No. ._ .3_ (�. /( � I (Complete in Duplicate) G// `--t Date Issued 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 5.49. "rf ..,,.,,.,_&, ADDRESSA LOCA ON.. c �rt - ---------- . - ----------- JOB Owner's N1 ----- ------- ------------•---- _- / Phon . _D_:-_-- Address....[J.`:.. •-•----- ---•-• . . ...•....�---~-------- .. ... . Contractor's Name--- ------- ----------------- ------------------------------------------------------------------------------------------- ------ Phone................................... Installation will serve: Residence Apartment House E] Commercial E] Trailer Court ❑ Mote) ❑ Othe Number of living nits: --- Number of bedrooms _ _. Num��Depth baths --?I)- Lot size __�_ •_X__Z _P----------------- Water Supply: Public system El Community system ❑ Private to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ P Previous Application Made: Yes ❑ No [+ New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publiq sewer is available within 200 feet.) f . Septic ank: Distance from nearest well_. r7 ist a from f �nd �pn___ ______________.Mater's)____________ ________,______._ _._ -_ No. of compartments........__ __i____'SiZ ....X_�_Q___�- Liquid epi+h_--__._�T______--__Capacity_•.___--__ ____- Dispos Field: Distance from nearest well.___..___Distance from foundation_�p_____________ i"stance to nearest lot irl�._ __�!�`"'")/ Pe Number of lines----- :._... Length of each line____________ _ fP.,_.___.Width of trench.____�C_ __ __�__:___.._.... Type of filter material! p t Q 9 e th of filter matenal_-_-f__.U-_-_- Total len th-----------L --o._-------•------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 171 Number of pits______________________Lining material-----------------------Size: Diameter-----------------------Depth_.___.____._________________-.__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.__._-______-.______-_---______--_-. ❑ Size: Diameter--------------------------------------Depth-----------•------------------------ ---------------Liquid Capacity............................gals. " Privy: Distance from nearest well-----___------------------------------_-------Distance from nearest building-------------._____-__-_-__-_-_______._. ❑ Distance to nearest lot line-----------------------------------------------•----•---------------•--------------------------------•..--•---------------------------------- Remodelingand/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 ordinance ate laws, and rules and regulptio s of the Sr 'J"o'a�q`uin Local Health District. (Signed) .._ �- ...... �_ `-Rw--�= ------------------------- ------------------------------------------(Owner and/or Contractor) By:-------------------------------------------------------- ---------------------------------------------------------------------------(Title)--------------•------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------- ---------------------------------------•---------------------------------- DATE REVIEWED BY------------------------ -------------------- ----- DATE.._. - ---------- --------------------------------- BUILDING PERMIT ISSUED-------------- ----._ DATE....--- - Alterationsand/or recommendations-------- ---------------------------- ------------------------------------------._.._. ....................................-•----------------------------••-- --------------------------------------------------------------------------------- ----------------------------------------------------------------------•-------------------•----------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------•--- ----------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------- -----------•----------- ---------- ---- -----.----------------------------------------------------------- -------------------------------------------------- FINALINSPECTION BY.------�.'-s,� c....�--------------------------------- 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