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f APPLICATION FOR SANITATION PERMIT Permit No. n. ' (Complete in Duplicate) Date Issued /`{43- 030 --(I Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and in tall the wS fk herein described. This application is made,in.compliance with County Ordinance No. 549. i 5� d Css •� j . JOB ADDRESS AND CATION ll = _� '---�_ _ _ _ _ -. --------- Phone Owner's Name________ __.- ----- r=______.- Address------_- - _Z-- --------------------- ---- --•--------------------------•------------------------- ---- Contractor's Name -r�_-__d`= �-------------------------------------------- Phone__Wd---6- C1� -C1.� G-/%�'.. Installation will serve: Residence [, Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/-_-_ Number of bedrooms -5-- Number of baths .-_f-- Lot size ______-2e -Xl _--_------------------- Water Supply: Public system I_Community system ❑ Private ❑ Depth to Water Table,0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe®,,Hardpan Q Previous Application Made: Yes ❑ No J-- New Construction-. Yes 0�,,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__, ?,.t-Distance from foundation----t�q__�--_-_-Materiai......&_ No. of compartments-.-_..- -.-_ __--___Size___ �d_ --Liquid depth_-___�- -__.-----Capacity.....__ _P`�____�91 `1 Disposal Field: Distance from nearest well-.-. 03e.Qistance from foundation___ -_!....Distance to nearest lot lin`_--- V` f ___-Width of trench._- - Number of lines---------1------ ---- -- Length of each line----------- -�.�=----------- X. ----- -� -------- r rI Type of filter.matenal___�j___--5>0-Depth of filter material_--.-�_�----`_Total length_________ _fl___________________-._ Seepage Pit: Distance to nearest well___4/Q _--Distance from foundation----14--j-- Distance to nearest lot line......f;______ Z Number of pits---- i - - ---------------Lining material_ld_C �e: Diameter----- -- -____--Depth------- -------------- . � � 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 line--- - ---------------- -----•----------------- -----------------•------------------------------------------------------------ -------------- Remodelingand/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 ordinances, St s, and rules and regulations of the San Joaquin Local Health District. �� _ '--_ -_______________ caner and/or Contractor) (Signed) ------ -- ><,1 ----- --- ----------------------------------- BY� -T •..�:. -Y►•� ------- - ---------•-----------------------(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 t � - APPLICATION ACCEPTED BY------------------- ----- --- �.; -------------------------------------- DATE. REVIEWEDBY---------------- ................... ------------ --- �: DATE ------ --------------------------- BUILQ]NG PERMIT ISSUED. --------------------------------------------------- DATE :�:5 Alterations and/or recommendations: -------------------------------•-------------------••--••------_------------•-------•--•-•-•----------.-------- --------- ------------------- ----------•-----------------••-----•------------•-------------------- - _T---------------- -------------------------------------------------------------------------------------------- ��------- - ----• - --- --------------�r- ----.-.---------------------------------------------------------------------------- ------------------------------------------------_-------------- FINAL INSPECTION BY---- ----------------- Date------�-- ----------- ---------l 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 T45446 ATWOOO 12-54 -