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APPLICATION FOR SANITATION PERMIT a� Nermif No. ---�- ?/ rL�1 (Complete in Duplicate) `t,�• Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit t cansruc and 'nstall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.__ SC _ �-- - - �------------------------------------------------------------------------ Owner's Name__ - + f _ .__7 't------- - �------ ----------------------- Phone--------------- . ---- Address--------- -�7 � 1.. -- Contractor's Name... . ------- ,Z� r-_5- 4•------� �C ---------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-___ Number of bedrooms _34- Number of baths Ik'Lot size ---- �. gCqm Water Supply: Public system ❑ Community system R—Private [] Depth to Water Table _ R.- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ ti Previous Application Made: Yes ❑ No (k-L_ New Construction: Yes jK_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well-R-0.0----Distance from foundation----Ia_t__---.Mat rial_ 9 IP [ No. of compartments.----.-- ! _----------- �e-- _Liquid depth------- ---Q----------Capacity-f -p------ Disposal --•--� �.- Dis osal Fieid: Distance from nearest well.._Distance from foundation__ p --.- --�� - __.��____.__Distance to nearest lot line______��.... (� Number of lines----------/�-___L. r.__ --- Length of each line_______'i� __._.Width of french.______--2--. - -Depth _ --�r---__----_ Type of filter ma#erial-_ �----- Depth of filter material----- ----___.Total length---.__�� T____________________ .,. r T �, r � Seepage Pit: Distance to nearest well_, ___Distance fr f un ion___-__.._ -��` � fit' ��__._..Distanc?lo nearest lot line_--_�J_______ Number ofits___.__-f-________._Lining material__-_ XqKS Diameter_--- . Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------------------------._--_______-•.� ,r _.Depth------------------------ (fr ❑ Size: Diameter --------Liquid Capacity-------•--------•--"---------gals. Privy: Distance from nearest well-________________________________.-------------Distance from nearest building--------------------------- ❑ Distance to nearest lot line Remodeling and/or repairing (describe):------------------------------------------------------------------------------ . y ------------------•----.------.---.-------------------------.-----------------------------------------------------....------------------------------------------------------------------------------------------------------ -------------•------------------ --------------------•------------------------------------------------------------•-------------•---•-----------•------------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 s, and rules and regulations of the San Joaquin Local Health District. (Signed}--- ---- --'. . --------- -E'�- _ _______________ _(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 - APPLICATION ACCEPTED BY--------- �� ------ DATE--------,>----------- _ REVIf WED BY. - --- --- ----.------------------•- -------------------------------------- DATE------ --- ------ --- �- _ =_ BUILDING PERMIT ISSUED---------------- -------- ---------------------------------------------------------- DATE------------- Alterations and/or recommendations: ------ -----fi--A ------------------------•------------------ ---• == a .._. - ------ ----•------------••-•----•--•--•-------------•-----------••-----------•--------------- ----- �� - - r �Y --------- -------------------- ---------------------------------------------------------------------------- -------------------------------------------------------------•-- FINAL INSPECTION BY-------- ---------- ----------------------------------- Date - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California r ES-9-21A 149446 ATWnOn 12-54 t f