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APPLICATION FOR SANITATION PERMIT Permit No. ..... (Complete in Duplicate) Date Issued -__.._' ��- t�3 —030-- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct an in I th work her in dd crib d. This application is made in compliance with County Ordinance No. 549. rr. JOB ADDRESS AND LqCATION.._4 ----- a - ---- F " - r ---------Y_� V Owner's Name---------�f�/[�.:.__ - �_.__ -- ' --••---------------- --------- - - ._ Phone----•------•---------------•---•-- Address----- --�•---� '---•- -c"�.----- •----��L-��,��:^�-------••--------- •--- ------••---------------------------------- -•----------------------- ------------------------------...._ Contractor's Name___=---4-$ -- ---------••----------------------------------------------- Installation will serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _ _ -1 I �.___ Number of bedrooms __�_ Number of baths ---!._ Lot size ____-__L>_ -- -•_t .� Water Supply: Public system "Community system ❑ Private ❑ Depth to Water Table .J Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan El Application Made: Yes ❑ No [ - New Construction: Yes V] 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- .N Distange]from foundation----lQMaterial_�f%- A,. - �- No. of compartments. s� J� (� : Size - -- -- - - - -------Liquid depth------1 �- --- ---Capacity---•X�-b-------- Disposal Field: Distance from nearest well-0a?_ Distance from foundation_____ _- __._.Distance to nearest lot line-___0_______ f .f------- ---- Length _r' e Number of lines-------- f- Len th of each line_________ __ Width of trench_____ -______._ Type of filter material___._...-: �> ---Depth of filter material___-__-- - --_---.Total length____--___� [`1 ' --- Seepage Pit: Distance to nearest well------�a {..Distance from foundation_____ -`--.•.Distance to nearest lot line___-___ ® Number of pits-------f------------Lining material_Fly Size: Diameter______ ' . ..---Depth---- -L__----- Cesspool: i Distance from-nearest well---'-----. ❑ ,:� well-=------------_Distance from foundation---_.________`__--_.Lining materia l___-_________-____-___- o Size: Diameter--- At - Depth_.- Liquid Capacity---------------------------gals. Privy: Distance from nearest.well__--------------- _-------------._-----------Distance from nearest building-_-----_-------------_ ❑ NL.. Distance to nearest lot'line----. ---------- ------------------------------- L k1__1 LA Remodeling and/or repairing (describe)_____ ------------------_*-- �' - ------------------------- --------•--•--•----- -• -------------- - ---------------------------------•--------------------------------------------------- ----- ----- ------•------------------------- -------------•---------------------•----•----•-------------...------•-----------•------•----------------------------------------•------------------•----•-----------•------------- --------- reby ce ' y I hethat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State ! ws, and rules and'regulations of the San Joaquin'Local Health District. (� 1 (Signed)--- ... �f - �g- _„ter-—- / ------------- --------(Owner and/or Contractor) By° I` , a -- - - Title -�, (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 BY------ _ •--•---------------•------------ -----•---- - ---------- ------------- ------------ - - ---- ---�-�--------- -----------•----------•--------------_ DATE- -------------- BUlLDlNG PERMIT ISSUED ----------------- ---•-_ - __--------•- DATE. "'---------------------------------- Alterations and/or recommend tions:----------------------- 1 '` --- --- ----�-- --------------•-------------••----------------------------------------.._._.. ---------------------------- -------------- --------------------------- - _ _.. --•--------------•---------------------..---------------- -----------• ---------------------------------•------------------------- ------- ---------------------- •---------------- ----------- -- --------- ---------- --------------------------------- --------------------------------------- BY: � S FINAL INSPECTION ..--__--��5. .----------_ `" I � Dat Date SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sfreet 132 Sycamore Street 814 North "C" Street Stock+on, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWpO❑ 12-54