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APPLICATION FOR SANITATION PERMIT Permit No. ........................ V (Complete in Duplicate) Date Issued ._/.Xf/2.. 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 Oo. 549. JOB ADDRESS AND LOCATION... -----� Owner's Name..---...Ce•..-- r". .C�-` -- -•--- ----------------------------------------------- -------------------------------------------- Phone------------------------------------ Address ¢ -----------------------------•--- -----••. - tom' Contractor's Name---------- ' ' "'L�i-' - . ._ Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: __t._. Number of bedrooms --2,, Number of baths ./... Lot size ._. K� _ ,_ _Z-________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9—Hardpan ❑ ' Previous Application Made: Yes ❑ No ga "New Construction: Yes ❑ No [n' 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--4�-------Materjal... 1� No. of compartments-- _.. __.______Size_.._X_q_�--__--__Liquid depth_._`__.-^ Capacity._..,e>'__0..__. ispo , Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line................. Number of lines-- ------------------------------Length of each line------------------------------Width of trench---------------------.--------_-_-- Type of filter material-------------------------Depth of filter material--------------.______..Total length----------------------.................... Seepage Pit: Distance to nearest well-_----_-------------Distance from foundation....................Distance to nearest lot line------_-__---_- � ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter-------.---------------Depth--------------------------------- Cesspool: Distance from nearest well-------------_-_Distance from foundation---.-------.------- Lining material-------------------.................. . 4 ❑ Size: Diameter--.-----------------------------------Depth----------------------------------------------------Liquid Capacity............................gals. Privy: Distance from nearest well --_------ -----------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line -- ----• --------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) _ •--___.. -•---•-------•••---•---•. ..-••;---------------•--------•--- ---------�'i�f�F_1`L' � _. �_ -."---- --•-------------------- --------- ••----------=--•- ---•----------•--------------•------------•-----------------•--•-•-•------------------•--------------------------•------•------•---•---...------•-•---------------------........--------•--•--...............---------------- 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, ay# rules and regglations of the San Joaquin Loca HealthDis+rict. (Signed)........... --- --- ------- `' - ------------(0 Contractor) BY� J (Titlej..:✓i�/f�°�L� ti --------------- (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY................. ` ---------- DATE....... ---------------------------------------------- REVIEWED BY-----_---- ------ - ----- ......... DATE BUILDING PERMIT ISSUED--------------- - DATE Alterations and/or recommendations:---------------- Y - -------------•---•-•----------•-----------------------...... =�4 -----------------------------------------------------------••-•-_•-•----------------•------------------..---------------- --------------------------------- .............................................................. FINAL INSPECTION BY: -5--------- ------- ------------ Date f `�--- yF` . __.___ ._.___•_. .f#.... q�ry 1 SAN JOAQUIN LOCAL HEALTH DISTRICT- k 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 5-9 145446 ATWDOD