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Y APPLICATION FOR SANITATION PERMIT Permit No. . �0-_ - Complete in Duplicate) 4/ V Date Issued `---------/-33--- Applica;-ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 5149. r JOB ADDRESS AND O ATiON...e]"0_ -u -_: "U ------•---------------- Owner's Name . -- ---------------------- ---- ---- I ------------------ --- ---------- Phone------------------ - ------ ------- - - ---------- Address------- -- -- -- -•-- ------- --..... ------------------------------- Contractor's Name---- - ` ----- - --- -------- --------------a.--- v. -----•-------. Phone. Installation will serve: Residence UL_Ajaart e�ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Y Number of living units: "" ---- Number of bedrooms " -- Number of baths ._/---- Lot size _--4/$6_" _ Water Supply: Public system ommunity system Private ❑ Depth to Water Table �3 `ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No 41q�ew Construction: Yes ❑ No t]------ f 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-----------------Distance from foundation-1404-._-----.Material-." - - - � --------------- CapacityNo, of compartment------ _ - depth- �s."-_---- Size._--"--- �-A�_Liqu id Disposal Field: Distance from nearest well-----------------Distance from foundation----x0------Distance to nearest lot line---- d Number of lines-""-" _�"-""._�..��" Length of each line--__ -J..---. . "-___.Width of trench.._,- �____�__-_-___- Type of filter material-_f _Depth of filter material------_-1 - ----Total length---'--'°�- --:-- ='�--�-------=�'-.: - Seepage Pit: Distance to nearest well----- ----------------Distance� fr m foundation------- .1-�-..Distance to nearest lot line-,f_.� Number of pits----,/ Lining material ".Size: Diametgr: Depth---_ !—----------- Size: � Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------_--.-----_ ^ ❑ Size: Diameter--------------------- ---- ------Depth------- -------------------•- '---------------------Liquid Capacity-------------------------•--gals. Privy: Distance from nearest well-------.---,------------- --------------Distance from nearest building-.--___--.---__----------"-""----------- { ❑ Distance to nearest lot lire-------- ----------------------------------------------------------------------- \ 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' I ordinances, St #e laws, and rules and regulations f the San Joaquin Local Health District. (Signed)" ` ntra t } BY= -- ---------------------------------------------- ----- --------- �r rte ---- ----------------------------------------- ------------ c or ---- -• ----------------------[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- REVIEWED ATE ------ --- REVIEWEDBY --- --- • ----------------------- ------- --------------- -------------------- ------ DATE-- - - ----------------------- BUILDING PERMIT ISSUED •------------ DATE------- A Alterations and/or recommendations:-"..-..---."-- - i -------------------------------------------------------------------------------- ti FINAL INSPECTION 13 ------ -------------•--------- Date---- . .-. . ... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreaf 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Mantaca, California Tracy, California Es-9-2 m 145446 ATWOob 12-54 , • F