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l0 L APPLICATION FOR SANITATION PERMIT Permit No. ----Y--_l••-•-� , (Complete in Duplicate) 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 Ordinance No. 549, JOB ADDRESS AND L ATION-_-----.?d y�/ Owner's Name--------------- ---------- - - - --------------------------- Phone------ -••------------------------- Address-------------1� Contractor's Name-------------P, -- 12 � ��------------------- Installation will serve: Residence Apartment House p Commercial E] Trailer Court [❑ Motel F-1Other ❑ Number of living units: -�- Number of bedrooms - - Number of baths I---- Lot size Water Supply: Public system eCommunity system .❑ Private ❑ Depth to Water Table _�14 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [R'Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weff� .-.Distance from foundation_ .�:6 -/ Com.e Q.�u I Material--------------'--- -------•--- --------------- No. of compartments----- - -.-------- ---Size--s`-..xyd .� Liquid depth----- os�----------.--Capacity.___1�_11__,0 ------ Disposal ield: Distance from nearest welO'�5+_Distance from foundation__3O-._____-__Distance to nearest lot line-_ [ Number of lines----------/- a S► __d_/-- Length of each line-------- ----...Width of trench----aye .r Type of filter material---0.1- ._Depth of filter material-.-__-/ -__------Total length-------�_,$------ ------------- eepage it: Distance to nearest well_`�L Q,�_ Distance from,, fpuf�dation---.S S________Distant a to nearest lot line./--d--_•____ Number of pits.__.--------------Lining material-q.�- _+--Size: Diameter-__.-3 esspool: Distance from nearest woJ1-----------------Distance from foundation--------------------Lining material-----------Size: Diameter-------- ----------- ------- ----- -Depth------ --------------------------------------------Liquid Capacity--- ------------------------gals. Privy: Distance from nearest well--------------------------------- ---------------Distance from nearest building 0 t ❑ 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, S to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- -----R"_ -- -- - -----------------------•------------------------------- -O erand/or Contractor) By:---------- - --- •- - (Title) (Plot pian, 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----------------- --•---�N Alterations and/or recommendations:---.-.---------------_--__ ---------------------------------------------------------------------- - ------------ -- ------•-------••-------------•-------------•-----------.-------------- ------------------- --------------------------------------------- -- -------------------------------------------------- - - -------------------- -- ---------- ------ 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-"3-2M 145446 ATWUUD i2-54