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A\N\�' � 1 Permit No. kA\ APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued Applica-lion 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 0 diAnce No ,649p tt r( JOB ADDRESS L ATI _- - --` ---_- __G l_ t _.._ _/. - --- -- ` - •-- - Owner's Name p _=7 =`'' `----------------------------------------------- ----------------------- Phone------------------------------------ r r t Address___________ _ _ Contractor's Name-- -- ... ------------------------------------------ Phone----------------------------------- ---- will serve: ResidenceWApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 1 I .>. Number of living units: ___ ____ umber of bedrooms ---__ _ Number of baths _-_____ Lot size ___ Water Supply: Public system i Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand,❑ Gravel ❑ Sandy Loam , Clay Loam E] Clay [:] Adobe�ardpan ❑ Previous Application Made: Yes E] No � New Construction: Yes [►�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sT, er is available within 200 feet.) Se tic ank: Distance from nearest well _, k_ /� _ '� p 0 Dista c� fro r foun tion_ _ _ _. _.Mat i�l---41,4_f{ _. f compartments Size --x-- --'A ----Li Liquid e h,--J Ca acit . No. o compar nts. .. _ .-/'`,. q p.1 p y Dispos Field: Distance from nearest well 4*6"Distance from foundatiolif- "Distance to nearest lot I' T' ��" Ell Number of lines.___.______ `:__�_ _______ Length of each line------- ___7�t� Width of trench..____ _'t._ Type of filter mate ri l~�epth of filter material-------- --------- g Total len th---------I-Z-Cl--------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line----------------- 171 Number of pits-----------___.....Lining material-----------------------Size: Diameter------------.----------Dept h____________________.____-__-_ 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 app' ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rule an re ulations fr the San Joaquin Local Health District. (Signed) r ___:_ _ ? _/_f__.____--: ------------------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 APPLICATIONACCEPTED BY ------------------------------------------------------------------------------------------. DATE_ -_ '--------------------------------------------------- REVIEWEDBY------------------------------ ---- -- -------------------- ------------------ ------------------------------------------- DATE- BUILDING PERMIT ISSUED. - DATE ...--------------------------------------------- Aiterationsand/or recommendations---------------------- ----------- ---------------------------------------------------- ------------------------------------------------------------------ ------ -- - --- --------------- ------------------------------------------------------------------------------1 ------------------------------------------------------------------ ----------------------------------------•-------------------------------- ---------------------------------------------------------- ---------/--- -----------------------------------------------------------------------------------------------------.....----------------------------------- - - FINAL INSPECTION BY --------- ;��-- --- - ------------------------ Date----- C�� ------- ------------------------------------------------ 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 A-F-0 12-54