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` - APPLICATION FOR SANITATION PERMIT Permit No. _._72 02._-. �s Complete in Duplicate) �/V Date Issued ----------------------- Applica}ion is Here y made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is �ade in compliance with County Ordinance No. 549. ed, A/e-c..� JOB ADDRESS AN LOCATION_, - .. - �9,�a..+-s.�..___ --�f IZ ------ ----- f}C�_t_; oq�A --------- t �{ `� Owner's Name-�--�---- -- ------- - --- - --------•• • Phone Address !_. �ft Contractor's Name � i-; ; Phone. dyV : Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ s Motel ❑ Other ❑ �y Number of living units: 1 `umKer of bedrooms.. Number of baths _.�.-_ Lot size __. 3._r_ -./_G Water Supply: Public•system El; Community system ElPrivate [ epth to Water Table -.. .._ ft. `\ Character of soil to a depth of 3 feet:: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0—Hardpan ❑ Previous Application Made: Yes ❑ No R?`—New Construction: Yes Ej--No ❑ { TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available'within 200 feet.) "E i . Septic Tank: Distance from,nearest well... �r-___.Distance_frgm fou dation--...1._Q..�...Materia��---�-e.l�..�-____---.. No. of compartments._.- ._�..P......Size_-S'.6.....��_.__-Liquid depth_------C,�_...--------Capacity__.F .d-_ Of 1 11 il op Disposal Field: Distance from nearest well_I _d___._.Distance from foundation.._ _...__-_.Distance to nearest lot line._..-_-..... Number of lines,___,_._.. ._. Length of each line-------- _�.. --------Width of trench------A-y_ �._..._-..._ Type of filter material._...Z s- -,-Depth of filter material.....l�_- -_-_Total length_._lac......................... 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_____-__....________._-..-__._-_.-.._°` ❑ * Size: Diameter--------------------- --„-----,-Depth-------------------:-------_---------------- ------Liquid Capacity-- •-----------------------gals. Privy: Distance'from� nearest well---------------------`-_,-------.-----------------Distance from nearest building------------------------- ❑ Distance fo nearest'lot "line-------- ---_,-----------------=---------=-------------------•-••--•---------•-----------------•----------------------------------------- � Remodeling and/or repairing (describe):-------' -4�-------S.- r-7-- - -----•-----•-••-•----------------------------- - - ------ .._ i -------- ----------------------------------•--------------- -----------------------------------------------------------------------------------------------------------------------•-•---------------------- I hereby certify that 1 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.. � -- - ` -------------------------------------------------------=-------- and/or Contractor)Sined} -t- ---(Title)--- ---------------------------- BY (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------- - ----------- ----•--: ----------------------------- DATE----it- ------------------•--•-------- REVIEWED BY---------------------------------- ------- DATI BUILDING PERMIT ISSUED -- . DATE Alterati ns a or recommend tions:--- -.._.- ------------ ------- - / -- -- - ----- � --•��------------------- � . ------ - -------------------------------•- - ---- --------------------------------------------- ---------- -- ----------------------------------------------------- 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 1 �E5-9-2M 145446 ATW000 12-54 - f �