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APPLICATION FOR SANITATION PERMIT, Permit No. _._71_[5_y_ = (Co�plete in Duplicate) Date Issued ___ ........... Applica�ion is hereby made to the San Joaquin Local Health District for a permit c nstruct and install the work herein described. This application is made in compliance with County Ordinance No. 544. �`] .�L�p� ! JOB ADDRESS AND LOCATION R,__0k yC----------•- -------- l� d-�'°.,�d_ �Q ,p Owner's Name_ . . lL D Xr .... 1 ----------------------- e�.----------14c�� 1T Address.--•----- .. = Contractor's Name.___ _______________ ______._. Phon. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�___ Number of bedrooms ___� Number of baths _�___h'Lot size ---- ------------------ Water, _________________Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ,�ft. Character of soil to a depth of-V et: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes)?g--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I-, e Septic Tank: Distance from nearest well___:��__.__---- .,� Distance from foundation__ ______.Materiai--- ......... v__________ KL No. of compartments _Size__ _____-_ P �----- - -- �� -J-e----Liquid depth....10--l.1-- ---------Capacity-----�a----------- Disposal Field: Distance from nearest well__ -_.Distance from foundation_____54.7------Distance to nearest lot line-__- ISFd__ of lines______________ _ Length of each line__.____.__. �.�___-.-.Width of trench---------- -------- Numberii, Type'of filter material----/,____I1�-Depth of filter material___._/_$_._`rAtotal length-------- -------------------- Seepage ____ -_____._ Seepage Pit: Distance -to nearest well__A ___Distance from f un�a i'on_______� ___.DistanceP nearest lot line____f_4.__ ! Number of pits------- -------------Lining Diameter------ ._._-Deptn�� Cesspool: Distance:frcm`nearest well--------------_Distance from foundation.--------------.-_Lining material------------------------------------- Size: ____._._..__..___.____.___- __"- Size: Diameter---------------------- ---- - -- ----Depth- ------- --- ------- - --- ----------------Liquid Capacity-----------------•------_--gals . Privy: Distance from nearest well-------------------------------------------------- from nearest building----------_---"__--_-___________._____._. ❑ Distance to nearest lot line-------------------------- --_ Remodeling and/or repairing (describe):------- ------------ --- --------------------------------------•----------•--------•••-----------------•----------------- ---------- E --------------------- ------------------------------------------------------------------------ ---------------------------•I----------•-•-------------------------------------------- ------------------------------- I hereby certif het I have prepared-this aapplication and that the work will be done in accordance with San Joaqdin County ordinances, Stat aw , and rules and regulations of the San Joaquin Local Health District. (Signed) -_ O er and/or Contractor B - {Title --- --------- - --------------- Y� -- ------------ ----------------------- (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 -S --------------------------- - ------ --------- DATE ----------- - - Alterations and/or recommendations:--- ------ ------ ---------•----••--•------•-•-------•-------------•--------•- - -- / -------------- ------------- --------------------------------- �- ------------------------------ -------- � - -------I------I-------------- ---------- �� :- ----------I ---• =-- ----------- _ --------- -"--•-•--------------------------------------------------------• -- ------. -..--- -------- ------------------------------------------------- ------------- - ------------------------------------------------------------------------------- \ ------------ 1-- ------ ---- ------ ----------------------- ---------------- ----------------------------------------•--------------- ---------- •-------- �__..� 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 E5-9-2M 145446 AT W P90 12-s4