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APPLICATION FOR SANITATION PERMIT Permit No. .53.77 L (Complete in Duplicate) -47 IY6 Date Issued ---- r------ -- 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 Ordinance No. 549. JOB ADDRESS AND LOCATION � " 1... :- `" ' F "� - Owner's Name-------- _/1[�C .. ---------•-•------------ ----- - ----------------- ---- ---------------- Phone------------------------------------ Address----------------71-�1_3 - -----------------...-•-----------Address----------------`1-� -3 r' ---------------------- Contractor's ----------------•--;Contractor's Name - ------ - ----- .. ---._. Phone-----------••---------------------- Installation will serve: Residence P`1 Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ r E Number of living units: __1____ Number of bedrooms _, _ Number of baths ___l__ Lot size __-Ls �_., - ------------------- Water Supply: Public;system pp y: ydr Community system ❑ 'Private ❑ Depth to �dater Table %-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay, oam ❑ Clay'❑ Adobe Er Hardpan ❑ Previous Application Made: Yes No .. pp ❑ New Construction: Yes ❑ No`8ii TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_) 'b .._'Dista`nce from ! uid'd. P.th--- Capacity -------------No. of compartments---- -----------------Size.- X-V.V---Liq ` o Dis sal Field: Distance from nearest well- U -IDistance from foundation_ Disposal_ _ ......l•.Distance,to nearest lot line__- �4___. [ ter Number of lines------------_- - -- __-- Leng}h of each line-------- -f--``�-''_--=Width of.t�ench,__.a- '-`F------------- ---- Type of filter material Ices __-_Depth of filter material____.,1 '_°`__-'Tota€ length_______.. _*--__________--..._ ( , �� r ------------- _e -- `� Seepage Pit: Distance to nearest welL.---)�f- Distance from four ation__a��__'____.Distance to`nearest lot line___.___.__._. .__+f--- ize: Diameter---� �--.-- [ Number of pits....--- ---Lining material_'- _ �C ""-----DepPh'..._... ------•---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining mater•ial------..--________..____.____-__--_- ❑ Size: Diameter----------------- - ------------------Depth----------------------------------------------------Liquid Capacity-----------------------------gals. (-1 r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.---------------------_------------------_- L ❑ Distance to nearest lot line------------- Remodeling and/or repairing. (describe)______________ x ___ )-4�---_. ��- -- f-------------------------- --------------------------•--------------------------------------------------------------------•-----------------------------------------------------------------------------------•--•-------------•------- ----- --- i - --- ------------------------------------------------------------------- ---••--------------------•---•----------------------• -.....------•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i l _ 3 _- . ------��- `� .,r�f.!€��.y �_ �, ..crc� (Signed) - .[O�a dAr Contractor) f --- --- B --------------------------------------------------- = --- -----=---------------- ---- Title------ y r (Title) plan, showing size of lot, location o system in relation to wells, buildings, etc., can be place on reverse siae). F ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE •----------------------- - -------------------------------- f RE� WED BY----------------------------- --- BULDING PERMIT ISSUED.----- - --- - - DAT*--------- - ns ------- - - -- DATE--- Alterations and/or recommendation ----------- --------------------------------------------------------- ------------------ --------- ----------------- ------------ ---------------------------------------•-------------"--•---••------•---•--------------------••--------- -------------------------------------------- ----- --------•---- ------------------- ----------------------------------------------------------------- ---------------------------------------------------------- F€NAL INSPECTION BY: •- --------- Date.. __._ SAN JOAQIJIN LOCAL;HEALTH'DISTRICT. 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" S+reat Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 A7woon