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Lam, APPLICATION FOR' SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ___�_ (!.Zf '.S=- a --c 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.compl'iance with County Ordinance No. 549. f � �_ -�-._AUS : OB A DRESS AND L CATION,.(_ Owner's Name � ,. � -------------------------------------------- ----- ----- Phone------------------------------------ `� �-- Address----------------------------------1.26-�`�_ -_ 4--_------�.:e = �Contractor's Name 2=Z_ - Phone Installation will serve: Residence _,Apartment House ❑ Commercial ❑ Trailer Court ❑ �fMotel ❑ Other ❑ Number of living units: J---_ Number of bedrooms -—Number of baths _:_ Lot size ...... -___________________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E) Sandy Loam [] Clay Loam ❑ Clay ❑ .Adobe 13, Hardpan ❑ Previous Application Made: Yes ❑ No ©:_ New Construction: Yes 19 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`,-ems---Distance from foundation----e�0----------Material__e__C_Z ---------- No. of compartments-----._.:5.----------- Liquid ------------Capacity---- a a_ Disposal Field: Distance from nearest well `D_"_Distance from foundation______4!!.._Distance to nearest lot'line__,5:7_'__. [� Number of lines--------- --________________Length of each line--------- `Vidth of trench_-_._ ------------- Type ------------ - T e of filter material___ � /SR,-._De th of filter material -_-_...Total length______,�—�' w_______________________ ... x Yp .�- =---- -- -- - p Seepage Pit: Distance.to nearest well-.,;$ ..______Distance from foundation___i2�._ _Distance t o nearest lot line__�� ___ [1 Number of pits._.__;;n-______Lining material_•' e.. 4'ke: Diameter_-.._ - Depth_ -46*-- ____________ rn Cesspool: Distance from nearest well-----------------Distance from foundation----------------.-_.Lining material------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. - / Privy: ., Distance from nearest we]-----------------------------------------------__Distance from nearest building----------------------------........ ' ❑ Distance to nearest lot line--- ---r-------------------------------------------------------------------------------------------------------------------------------- . d Remodeling and/or repairing (describe)---------- ---------------------------- -----••------------------------------•------------------- -------•------------------------------------------------ r ------------------------------------------ --------------------------------------------------------------------------------------------------• ----------...------------------------------------------- ------ 2 ------------------------------------------------ ------ I hereby certify that 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. f ------- (Signed) / Owner and --.....• - y / ----------------- - - - ---------------------------------------------------------------( /or Contractor) By:---- !,L - !---. Kfsy L -----------------------------------(Title)------ = --------------:------------------- (Plot-plan, showing size of lot, location stem in relation to we s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- ---------- - --- --- --- -------------------------------------------- DATE----� --------------------------------------------- REVIEWEDBY------ -------------- - ------- -- ---- -- ------ --------------------------------------------- DATE--------- - ..... BUILDING PERMIT ISSUED--------------------------------- -------------------------------------------------------- DATE.---------- •----- Alterations and/or recommendations_______________________ ____________ _ 5 , - -------------------------------- ._: _ = - ------------------------------ --- ----- ---- - ------ ---- - - - --------- -------------------------------------------------------------- --- -. • ---------- FINAL INSPECTION BY--------- --- - ---------> _---------------- ------ Date----- :.� :�..``Y------------ ----------------------- 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 14544E ATWOOD