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r1�'Y1~ nn APPLICATION FOR SANITATION PERMIT Permit No. .--l-d- __- (Complefe in Duplicate) Date Issued Appliceion 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. S4 . a JOB ADDRESS AND LOCATION_-- ------- ----- ----- _ - --------- Owner's Name- 'fes.. ---------------•------------• -I----------------- --- -- Phone Address------ Contractor's Name------- ll� � T:------- ----•--------------------------------•---------•------- Phone./... .. Installation will serve: Residence Apartment House ElCommercial L] Trailer Court E] Motel El Other E] Number of living units: .-T---- Number of bedrooms __ Number of baths __J--- Lot size -----zr-Z)---AAn , Water Supply: Public system`5;r-. Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobep Hardpan ❑ Previous Application Made: Yes ❑ �No PC_ New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is availablewithin 200 feet.) r Septic Tank: Distance from nearest well---------------�Distance from foundation--.-------.--------Material El No. of compartments----- -----------------Size--------------------------------Liquid depth_....-- ------- ---------Capacity---•-------•----------- Disposal Field: Distance from nearest well--wo-L"istance from foundation___- - . ___ ��e �_ Distance to nearest lot line____ Length-of each line--------- ----y`Y Number of lines---_--.--I----�� - 1t----.Width of trench--------�-�---------------- Q Type of filter matenaL-f! ----,�� _Depth of filter material----._J_ ... ' ' ----._.Totallength------•--'-�- ---------------------- ---------- Seepage ------------------------• 1J i Seepage Pit: Distance to nearest well... - -47iZ.--Distance from foundation----_�.-......Distanceto nearest lot line _-.- r] VL Number of pits---------i-----------Lining material_le&�e: Diameter--_--- � Depth----- Cesspool: Distance from nearest well-----------------Distance from foundation-.................. Lining material--,--_-----_-----------_-----_----- m ❑ Size: Diameter----------------------------: ---------Depth-------- -------------------------- --------------Liquid Capacity- --------------------------gals. , a Privy: Distance from nearest well---.-_.'____________________.__ -`_ f -------__-Distance from nearest building------------------------------------------ ❑ Distance'to nearest'lot-line- -.--° - ---------------------------------------------------------------R. •----------- �. T Remodeling and/or repairing (describe):-- - -------------------------------------------------------------- �p ----------•------------------ l ---------------•----•-- , ---------- ----------------------- ---------------------------------------------------------------------------------------------------------------------------- -•----------------------•---------------------------------------------------•----------- I herebP- 1 have prepared this application and that the work will-be done in accordance with San Joaquin County ordinances, d•rules and' regulations of the San Joaquin Local Health District. (Signed)..-----• ---- r - ------------------------- --------------------------(OFc-: r an Contractor) By..Y•. -• - -- --•-•- -- ---------(Title) ------•-------- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- - DATE------ --•----•--------•---------------•--------------- REVIEWED BY-------------------------------------- = DATE ,,� ----------------------•- --- __ BUILDING PERMIT ISSUED------------------------ - - --- ------- -- •----------- DATE-- ----------------- - Alterations and/or recommendations:-------------------- ------------------------------•----------•----------- 4-- -� f---- `~ ---- ._- ------------------------------• ---------••--••---�----- ----------..----------------------------- --- ;� -- ---- ---•---•--------•--- -------- ------------------------------ ----- FINAL INSPECTION BY: -�C - --------- --------------------------- 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 E En-9-2M 145446 ATWL10❑ 12-54