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�N U 1� APPLICATION FOR SANITATION PERMIT Permit No. —I (Complete in Duplicate) 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. 6._. --------- �_.. JOB ADDRESS AN��LO TION---- _. -0.i(2-6_----- Name----off l ! ._. ---------------------------------------------- Phone------------------------------------- Owner's Address_.....2-• .r!. Cj: '--------------------------------------------------------------------------------------------------••------------------.---------- Contractor's Name------ i4F ---- ----`� --�--�------------------------------------•----------------------------------•----------------------- Phonex•-+__`nC'12�.4--i--11'----- Installation will serve: Residence E� Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: _1--- Number of bedrooms -_2— Number of baths ---/--- Lot size ------- �1-., -___;�.�__ ____________________ Water Supply: Public system 4--Oemmunity system ❑ Private ❑ Depth to Water Table t._:Pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ?Ta.a•_ Distance from nearest well-----------------Distance from foundation------------------_Material----------------------------__...,..._f'_-._... No. of compartments- - --------- .--Size--------------------------------Liquid depth----------- ---- --------Capacity------ ---------------- Disposal Field: Distance from nearest well_.-7p-'....Distance from foundation-----1.�___-Distance to nearest lot line.-- --___._.. Number of lines__-.-.-: 1T-- ---- -___Length of each line-__._j,PZ.._- Width of trench_.A Y----r_------------------ Type of filter matercal__/-. ._- -------Depth of filter material-------- --- length._-__-r - ------------------------ i Seepage Pit: Distance to nearest well--- _ ......Distance rom- oundation---� -----.Distance to nearest lot line......-_--. ��►- Number of pits....Z---------------Lining material.--------Size: Diameter- Depth- -------------------- Cesspool: Distance from nearest well---------------- Distance from foundation___---------------- Lining material--------------------------------------- Q ��--�-r SizerDaarrmeter__----_-- ------------Death- --- ---------------------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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)..-- � ------------------ -- ---------------------------------- -----------(Owre�bl' Contractor) Title By:--2�t- o { ' ) {pIo} plan, wing size of ilocation of system in relation to wells, buildings, etc., can be placed on reverse side]. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...................... ......... --=-- ------ ----------------------------------------------- DATE----- —---------- --- ----------------------------- REVIEWED BY------------------------------------ DATE -... BUILDINGPERMIT ISSUED---------- ---• ------------------------------------- ---------------- DATE. d ------------------ Alterations and/or recommendations:---------------------- ------ - •--•----•- ------ •-•-•------•---- ---------••----------------•------------------------- ---------------••--•-------------------•--------- -- -- ---- --- = 1.. --- - -- -- -----7 --- - -----•------- _____ ____________ ________ ________ ---------.__-----------------. .__. Date----------------------------------------.--------------------------'----------- F A _ FINAL INSPECTION BY:.':-------------�' t-' --------------•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 A7WOOD 12-54 n: