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APPLICATION FOR SANITATION PERMIT �•a Permit No. ..1_____________________ (Complete in Duplicate) 4Date Issued ---- ------------------ Applica+ion is hereby made to the San-Joaquin Local Health District for a perm�to,co r ct and install t e k herein described. This application is made in compliance with County Ordinance No. 549. CJ ((FIJI�� fJJ - JOB ADDRESS AND LOCATION------- + J £ , mc.e-------_----L.tQ-� � C,------------------------------------- Owner's Name------ ----------------( -�j J �� ----------------- ----------------------------------------Phone--------------.---- ; Address---------/ l....••-•..,/r�.lG: .-. ------------ -•-----------' r------------------•-----------------•------------------------------------------------ Contractor's Name-------- . ------------ - --- --- ------ ------------------------------------ Phonel __�= d a Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-�_-- Number of bedrooms .- Number of baths _ Lot size ______�---. r t.R...t------------------ Water Supply: .Public sysfem' ❑ Community system [4_,Private'❑ Depth to Water Tablet. p�a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe RL Hardpan ❑�y r Previous Application Made: Yes ❑ No 5—New Construction: Yes OL 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 well_r_-!---Distance from foursn jation____ _ __________Material.___ ._ _________________________________. No. of compartments_.._..------- S-sze._t::1_�__ fl-rP..Liquid-depth---- Capacity____I Disposal Field: Distance from nearest well_ Distance from foundation__._f _ __ � _-Distance to nearest lot Number of lines___.__.____/ __ - Length of each line._____.___.- Width of trench.__ r�__�_ __________________ I ----------- !/ - f Type of filter material__ S "`.'._Depth of filter material.____,__/_ .__-Total Jength------- ________________________._ Seepage Pit: Distance fo nearest well-..,~- -------Distance fr m d ou ation_= p � _ _.Distance nearest lot line________. E1___._------Lining material .. e: Diameter____..; `____Depth._. .5----______.-_-___ WL Number of pits------ ' Cesspool: Distance from nearest well___.__.___.___Distance from foundafion------------------- 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 application and that the work will be done in accordance with San Joaquin County- ordinances, State laws, and rules egulations of the San Joaquin Local Health District. -e �--- -- -- -----------------(Ow and/or Contractor) (Signed----------P i_. net B ------- ( ) Y:-----. 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........�---------- ---------- ---------=------------ REVIEWEDBY--.--------`=-------------------------------- ------ ---- -- -------- ----------------------------------------- DATE--------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------- ------------------------ DATE---------- - - ---- Alterations and/or recommendations:------------------'- - ------ ---: �• -------------------------- --------- --:- --------- ------------------------------- -------------••-----•------------------------•--•-- ........-------•- ----------------- s�--- - ------------------------------••--------------------------. -------------------- ---------•------------- ------•----------------------- FINALINSPECTION BY:.--- ---------------------= -------------- Date.....l-'--- = +------------------------_-.----------------- 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--9-21A 145446 AYWOnD 12-54 i