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p- APPLICATION FOR SANITATION PERMIT Permit No. ... 0............. U [Complete in Duplicate] la Date Issued Applica ion 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 Ordinance No. 549. JOB ADDRESS AND LAOCATION..----------� �-`�-------- Owner's Name-------l-lV_A._._4 �_ Phone- -- ---_--•---....... Address---------------------- " �- ---- . � .- ------•-------------------• ---- --- Contractor's Name---_-+�.�.-�---`)�---S-�_1.�`_-- -a______________ _ Phone__-- ------ Installation will serve: Residence []--*'A"partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---- f-_ Number of bedrooms _. __ Number of baths I--- Lot size ....... -_---_14-_ -A-0............... Water Supply: Public system lk<ommunity system ❑ Private ❑ Depth to Water Table --- -_- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 99 Clay Loam ❑ Clay ❑ Adobe ®/(hardpan ❑ Previous Application Made: Yes ❑ No R--'-N'ew Construction: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4�Septic Tank: Distance from nearest well_.1407s.A.lDistance from foundjJtion__1__4____.-.__._Material,________ _________________ ____________�. No, of com artments.__ Size_-___ - q pffi . . .Capacity----�-_-- - ��- p � - - � - -•---Li uid de th--- .- -- - -- f' / Disposal Field: Distance from nearest well_ __ __ ____Distance rom founds ion--- __ _ Distance to nearest lot Ile______ _________ �• --------- CSL (P� Number of lines_______ ____ _______ Length of each line_ e______ Width of trench.___ _.___----------.--__-. Type of filter material- -------_-- Depth of filter material--- .Total length-----6-Q--_'--------------------- 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 to nearest lot line- -----------------------•--------------- - ------------------------------------------------------------- Remodeling and/or repairing (describe)_-----------_--------------------------------------------- ------------•--••----------------•--•-----•-------•---------------------------------------------------------------------------------------•------------------------------------------------••--------------------------------- -------•----•-•------------------------------------•-------------------•--...._...-------------------------------._...------- _-------------------------------- --..._..--------............................... I hereby certify that I-have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) `v ----- p! -------------------------------- for Contractor] 9 ----- Sep! !r ,.� By: ]20fa .. Eldorado H®2-70 6 (Title)--:-- - - ---- ------------ (Plot plan, showing size of lot, oca ion ro ysFem in relation , etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY, APPLICATIONACCEPTED BY--- ---------------------------------------------------------------------------------------.- DATE_;;------------------------------------------------------ REVIEWEDBY -------`--------------------------------------------------------------------- DATE BUILDINGPERMIT ISSUED-------------------------------------- ------------------------------------------------------•• • DATE-- �---------------------------------------------- Alterations and/or recommendationis: (5�--•-•--------• ------------------------------------- ------------------•----------•--------•-••-------------•----------------------------------- --•----•--•-- ------•--------------------•-----•---- ---------------- -----------------------------•-------------- -------------------------•--------•-------- --------------------------------------------------------------------••--•------------------------------•---••------- FINAL INSPECTION BY: = Date l b = -- -- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Prodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWCOD 12-54