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APPLICATION FOR SANITATION PERMIT Permit No. .....!___d__ . (Complete in Duplicate) Date Issued ---- I __. - - I - /�3 --0 30—2, Applica+ion is hereby made to the San Joaquin Local Health District for a permit to nstr�{ct n install the work herein ed. This application is made in com Bance.with County Ordinance No. 549.C' � i ... � 1� JOB ADDRESS AN TION__ . ---�-�---- -----•• Owner's Name �� -------------------------------------- -- Phone Address1 r / ----------------•---- --•----------------- -----------------•--------•---------•-•-----.----- Contractor's Name________ ._.. ,,��jj - - - -� - ..--- -• -------------- • --• - --------------------•------------------=--.. Phone-_!�;{_.(p--'-' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--f__ Number of bedrooms _, -Number of baths ._ ___ Lot size _______�_- ....y___qg_--____________________ Water Supply: Public system 51 Community system ❑ Private ❑ Depth to Water Table 13 34__� . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeg Hardpan ❑ Previous Application Made: Yes ❑ No (& New Construction: YesA 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__ _ istance from foundation__- _0 e- A,-----�- Pf1aQ,A 1 Material -- - ------�--------------- �` No. of Compartments____-ss - ------------- P_ _:56---------_Liquid depth-------Zn4- --------Capacity___---��____-- _ 1 � S Disposal Field: Distance from nearest well...A/"7.,-�+stance from foundation___l_�___,_____.Distance to nearest lot line_____..._. Number of lines-------------/_ - - Length of each line___-_____-�4�_- -------Width of french--------v�+- __.___-_______ Type of filter-material- _�_�_�- --------R-Depth of filter material___1-_ �� Total length_________�-_S'�______________________ - - tSeepage Pit: Distance to nearest wel1_1VI!r12U __Distance from.fovndation____ _______.Distan e,to nearest lot line__-,_.'-__ Number of pits--------/------------Lining material_e,� frze: Diameter-_-----�- -------_Depth...... -_________________ Q Cesspool: Distance from nearest well-----------------Distance from foundation.-----------------,.Lining material____--____--___-____-_______________- ❑ Size: Diameter---------------------------------------Depth----•---------------------------- --------.--------Liquid Capacity------------------------_-gals. 1 , Privy- Distance.#rom nearest well--------------------------- ---------------------Distance from nearest building__-_______-__.____-_________________-___. ❑ Distance to nearest lotline V---------- -------------------------------------------•------------------------------------------------------------------- D 4 1 Remodelingsend/or repairing (describe): ----------------- ------------ ---------------------------------------------- -------------• ••--------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------•-----•----------------------------------•--------------•------------------- ------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ' I hereby cert' t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws and rules and regulations of the San Joaquin Local Health District. (Signed)------------ ---- ----- ------ -- ---- ------------------------------------------------- {Owner and/or Contractor) B :__ ---------- - -- -- -- Title -------------------- Y ) ---- (Plot plan,sowing size of lot, location of system in relation to wells%uildings, etc.,-can b'—laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---- -------------------�" ---------- --- -------------------------------•--------- DATE-----------•--------------- ___--- •----------------_ REVIEWEDBY-------------------------------------------- ------- - ------------------------------------------------------------------- DATE--------- ----•---- BUILDING PERMIT ISSUED----------------------------------------- .. RATE.. Alterations and/or recommendations:---------------------- - _ . ---- ---- ------------------------ ------- �a----------°--- -.-------------------------------------------------------------------------------------- ----------------- 1 u--------=----------------------1-1---------- ------• �----------------------------------------------------------------- ------------------------- ------------------------------- -------------------------- ------------- -------------- - FINAL INSPECTION BY:_---- -------------------------------- Date- 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-9-2M 145446 nrwono 12-54