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�r IT Permit No. . {- ,5----- APPLICATION FOR SANITATION PERM 7/ V (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 Counfy.'Ordi6lance No. 549. [' JOB ADDRESS AND LOCATION--C��_�-- ---`- --- -----•---- -- ----------------- -- Owner s Name - ---•- ----------• - - - ------ e ' ---- --- Phon fft ---------------•-------•---------------•----- - ------------------------------•--- Phone----------------------------------- ouse Name---- -----------•-------•- --- --P----------••---•----------------------------------------------- -- Installation will serve: Residence [{A artment House ❑ Commercial ❑ Trailer Court ❑ Mote �/Other ❑ Number of living units: _I____ Number of bedrooms _Z_. Number of baths __/____ Lot size __ --- 7 1 Water Supply: Public system VCommunity system ❑ Private-E] Depth to Water Table "------ ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ adobe eHardpan ❑ Previous Application Made: Yes F1No ❑ New Construction: Yes El Na ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ub�tc sewer is available within 240 feet.)t Jf� r =/ Matsrial �•• � Septic ank: Distance from nearest we11jj�________-_ Is�ancr from fQ cat r No. of compartments----------Z# --- Size K-�Q_�P�uid yep.fb bCapaa#Y = # II is#ante to nearest 10# !in Distance from foundati r --- -- - A ,i Dispos Field: Distance from nearest well __ .. .-- -- 'Width of trench_._ - - Number of lines-__-- ---?i_ --------------Length of each line----_- `- ----- ± Type os filter mater °_ -Depth of filter materia!__-_._ ` ---------Total kength___-.---- .f_ _____________________ — Seepage Pit: Distance to nearest well`.___`_"_-_____-. _Distance.from foundation_ ___ __________Distance to nearest lot ine----------------- ❑ Number of pits =-------------Lining material" ; -Size: Diameter-----------------------Depth--------------------------------- .. . �� -:- Cesspool: Distance fiom�nearest well'-.------Distance from-fou dation__--__________._._lining material_---------------------------------- D _____________ __ gals. ❑ Size: Diameter ---------------- ----------Depth------------------- Liquid Capacity - ' f ' Distance from nearest building v1I Privy: Distance from nearest well-------------------------------- g 171 ��.Distance to nearest lot line----------------------- ----------------------- ----"- -----------•----'•----------------------------•---------------------------------------- y __ ,�( -1------------ Remodeling and/or repairing (describe)-----------------------------•--------------•------ ------ 4,...,., t --- ------------------------------ --------------------- ----------------- -------------------- ---------------------------------------------- ---------------------------------------'-'----------------- ;1 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. y --------------- (Owner and/orContract Contractor) v ------ (Signed) n_ � -____-______-____ - �_ _ ----- (Title) B -------- �x.__ --------- n --•-owin buildings, etc., can be placed on reverse side}. (Plot plan, showing size of lot, oca�ion of system in rely+ion to wells, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE—�----------------------------------------------------- REVIEWED BY s --------------------------------••----------- DATE-,---.r BUILDING PERMIT ISSUED----------------------------------- ---------•-------- ----- DATE Alterations and/or recommendations:----------------------------------------------------------------------------- ------------- ___ y...-+may ----•---•----•-----------••--------- -••------------ -----------_--------------I_ y y -------------------------------____----------------_----___�__ ___________-__..___-______--____ FINAL INSPECTION BY:-------------------------__________ _ � Date--- ----------- ------------------------------ -----------••----- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California t Stockton, California Lodi, California Manteca, California y. �� nu oe.... 4 W.1 Inn -