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13 CO \� APPLICATION FOR SANITATION PERMIT Permit No. _44e; (Complete in Duplicate) .... �'l S Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install Dee Issued This application is made in compliance with County Ordinance No; 49. JOB ADDRESS ANDjLOCATION_____ { -------- Owner's Name----//'�2 -- --------------�------------------------------------------------ Address---- _- __. Phone / .-_.- --------------------•••-._ Contractor's Name----/'_ y--------------------------------------------- ------------ Installation will serve: Residence --------------------------- --- --- ------------- artment House ❑ Commercial Number of living units: __/---- ❑ Trailer Court ❑ Motel ❑ Other ❑ r�_ Number of bedrooms __ - Number of baths /-_--- Lot size ___� Water Supply: Public system 0—community ----------------------------- ommunity system ❑ Private ❑ Depth to Water Table �v ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Previous Application Made: Yes ,� � Y ❑ Clay ❑ Adobe�—}��dpan ❑ TYPE OF INSTALLATION AND SPECIFIC 6—New Yes [fes-pf6❑ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel_ -__Distance from foundation___ ----- No. of compartments__-__.2------------- MatFrial__. i.G-^ Size--�-.1--�-�b_.___Liquid depth . _ � , Cap - -------------------------- Disposal Field: Distance from nearest welJlY__ - - acity_._ ' `- _Distance from foundation_. �___'-_--Distance to nearest lot line-__ �-- Number of lines______-__.,/ ' r--------------Length of each line l' ` f- -..Width of trench _ ' �- Type or filter material____ -___ Depth of filter material__l p Seepage Pit: Distance to nearest well+ -«� -------Total length___.___c�_--_•_ J --------- Distance from foundation___ _-----Distance to nearest lot line_ ------------ Cesspool: d �`-- Number of pits__.f-_._.__ ____.Lining material_ -F't'"=' _Size: Diameter_ / .�.�.l---______.Depth �:� � �'_ 04 Distance from nearest well-_____-_____._-Distance from foundation__ _____Lining material____-__.--__-_-__ ❑ Size: Diameter_____ _ _______ - -------- -------Depth---------------------- - --- ---------Liquid Capacity--------------------- Privy: Distance from nearest well----- - -------gals. r Distance from nearest buiIdin Distance to.nearest lot line-- ----- ---------------------------- 9----------- •---------•-----•--------- -------- - - Remodeling and/or repairing (describe)------------------ -- --•----- --- ----- -- -- ---------------- - ----------•---•---.---•----------•----•-------------•-----------•--- I hereby certify that I have prepared this application and the+ the work will be done in accordance with San Joaquin County ordinances, awe, an rules a d regulations of the San Joaquin Local Health District. (� q my (Signed) } ` ----- -------- - BY� l y�.,�' - Co - -- - y Contractor) (Plot plan, showing size of lot, location of s s+em in relation to wells, buildings, etc., canbeplaced o �reverse side). FOR DEPARTMENT U_SE ONLY APPLICATION ACCEPTED BY---------------- ---- _________--___.___.- REVIEWED BY--------------- VS ------------------------- ----- DATE @----ttf---=-y f'------------------- - - ------------------------ BUILDING PERMIT ISSUED.__________-_--_- --- --- ----- ------------------------ - ------------------------------------ DATE-------------------------------- -- ----------------------------------------------------- -- ------------------------ ----------------------------- DATE A+era+ions and/or recommendations-------- ------------------------ -_-.---------.-.-- -------------------------------------------------------- ---------------------- ----------- --- - -------------------------------- FINAL INSPECTION BY:...- �-f , l� j1 - ----•---- Date------------------L'-- --------• ----------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes} Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street Lodi, California Manteca, California Tracy, California ES-9-21A145496 ATWOpD 12-54