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APPLICATION FOR SANITATION PERMIT Permit N 4 o. ----------- (Complete in Duplicate) / -7 Date Issued ----- � Application 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 O dinance No. 549• I ® JOB ADDRESS AND LOCATION — A�0----. -. --------------------------------------------------- Owner's Name---------- ----- ---- -- ------------------------- Phone-A67---� 2—_-1 Address-.------------- ---------------------------------- `2' � --------------- ----------------- Contractor's Name---- a, — - ---- - '----- •� Zn r-.. - - �`-`-.-. - -------------- Phone- ---.;1�Q�12_ Installation will serve: Residence Bf Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: �-- Number of bedrooms -YNumber of baths _-f-__ Lot size ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water TableFDft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [j Clay Loam [] Clay E] Adobe Hardpan E]i Previous Application Made: Yes E] No New Construction: Yes ❑ No�tiA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool-permitted�if-public'-sewer is'available within 240'feet.)' -�-r- - Septic Tank: Distance from nearest well._ti( d]LjL-_-_Distance from foundation-j-Q----___-_--Material----------------- c 4 - No. of compartments-- Z-------- - -------Size_-�_--`�--U----_ Liquid depth------ ��- -- Ca acity- - I r i �;�,, P Y = Disposal Field: Distance from nearest wefl_14-am— -Distance trom foundation___-1• -! --_-Distance to nearest lot line--------f I Number of lines-- --------- ------_--Length of each line---- --� -------- - ---------Width of trench...... �1�-r------- ------ Type of filter material_ ,._4------Depth of filter material-_--_L�_�c:--__--Total length---- p--------------------- F Seepage Pit: Distance to nearest well---N_an�----Distance from foundation--VjQ_`-Distance to nearest )of line-_.__ Number of pits__._L---_---------Lining material_'_� Size`Diameter---_-_ �+ r -- , _ ) _ ��------ Depth-- --�,.L?--- --------- Cesspool: Distance from nearest well--------- from foundation_------------------Lining material------------------------------------- El � ` Size: 'Diameter' ---- `------'----------- - ----Depth-----------------:---_ _Liquid Capacity I ------- ------------ - ----- q -- ------------ ----------gals. Privy: Distance'from nearest well___--__--.-.__----______.___-_- _------_Distance from nearest building . .. - 9 ------ -. \� ❑ Distan*fo nearest 10,line-----------t--------------------------------- ------------------------ ---------------------------------------------------- Remodeling and/or repair'in`g (describe):-_i--------------1c�----- --------------------------- - ---- ------------- ------ ---- -----� �---------'------ ----- --------------------•------------------ --------------------- _.--•-----------------_.------------------------------------------------------- ---- 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. (Signed)- v_'"-- ct---------- O+vs� a�[�r Contractor) By:--------------------------------------------------------------- �( , (Title)--------------------- - - (Plot plan, showing size of lot, location of system in relation to els, uildings, c:, can be placed on reverse side). R DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-- - - � .-----__ G 12EVIEWED BY i - - ------ DATEj �� r --- ----- - -- ---- - --- DATE PERMIT ISSUEQ-------------------�---------------- - - ------------------------------------ - ----- --- --------- ------------•-------------------- Alt�t' nd/or recommendation :----�---- ---------- - AT ------------------------------------------------------------- s �� J -- ----------- ---------- ------•--------------------------- - ------------------------41-•-- ----------------------------- ----------------------- -; ------------- -------------------------------------------------- -�1 FINAL INSPECTION 8Y:- -- -------------------------- Date >r T - YG1 iSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Noah "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M . Revisea 1-57 F,P.CO. i