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APPLICATION FOR SANITATION PERMIT Permit No. X13 (Complete in Duplicate) I Date Issued --;I,,--- ' Applica4-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. 544. JOB ADDRESS AND LOCATION.-,--- ------ `----------&/<----- ------------------------------- --------- ----------- --------------------------------------------- -- ;1411 Owner's Name-------------- '� -i-- . + --------------- ' Phone 4 Address_----•---------------------------------------------••-•-------------------------------------- -" ,gyp_"�,,,, --�--------------------------------------------------------------------------------------•------------------------ Contractor's Name------------------Rr t *r`O'�-----------------------------------------------•--------------------------------------------------- Phone----•---•-------------------------- Installation will serve: Residence gEr "Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living ___ units: --- _ Number of bedrooms ._ Number of baths __/_-_ Lot size -------�p _ r Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [B--Hardpan-EI -,a Previous Application Made: Yes [] No D----New Construction: Yes Er-K-0 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic tank or cesspool permitted if public sewer is available within 200 feet.) Material----_ Septic Tank: Distance from nearest well.�6�Distance from founds n------�'........ V No. of compartments------ ------------Size__#X_,fzl`_ iquid depth------------ .__-.. - Capacity..--r—f/if S Disposal Field: Distance from nearest well.................Dista from foundation--------------------Dis#ante to nearest lot line-------------- Number of lines--------------------- ------ - -- ength of each line---------------------_-------Width of trench----------------------------------- 2 Type of filter material---_______---------------Depth of filter material-----------------------.Total length-------------------------------._-----_-.- Seepage Pit: Distance to nearest weft----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material------.----------------Size: Diameter-----------------------Depth----------------•---------------- Cesspool: Distance from nearest well-----------------Distance from foundation____---- __ -------- Lining material--..--_-___-__.________------------. ❑ Size. (Diameter------ ----- - ----------- ----------Depth.----------------------------- -------------------Liquid Capacity------------------------- Privy: -------•- --------- gals i Priv Distance from neatest well---------------------- Distance from nearest building ❑Y ------------------ -------------- -------------- ---------- -- Distance to nearest lot line ----- --------------------------------------------------------- ------------------------------------------ V Remodeling and/or repairing (describe)---------- ---------------------------- ---------------------------------------------•--------------•-----•---------------------------------------•-- Ar ----------- ---------------------------------------------------------•- --••--=---•--------------------:------------------------------------------•-----------------------------------------------•-----------•--------------------- ----------------------------------------------------------•--•-------------------------_----••--------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statelaws nd rules and regulations of the San Joaquin Local Health District. a. � (Signed) / --- -- -- ------------------------- ---------------- ------------------------(Owner and/or Contractor) B- ----------------------------•--•---------------------------------------.-------------- --------------------------------------------(Title)--------------------------------------------------------------- ' (Plot pla , showing size of lot, location of system in relation to wells, buildings, etc., can be placed on.reverse side). 't .a. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --------- ---=---- ------ - - A '7._ =-- --------------- ---------------- DATE----------- ' "J`� --•-•-------- REVIEWEDBY-----------•--F------------------------------ --------- ----------------------------------------------------- DATE------------------------------• --------------------------- BUILDINGPERMIT ISSUED----------------------------------------------- •-------------------- -------------- DATE------------------------------------------------------------- /--------------------------eafi ---� _, ---- ------------------------------------------------------------------------------------------------------- --------------------- Alterations and/or recommen atians_____________ _ � ------ - - - - ---- _0 ------------------------------------------------------ 1---- - - - --------------------------------------- ---------------------------------- -----------------, -----------....... ...............-•--------------�4------------------------------------------------------------------ ------------------------- FINAL INSPECTION BY:...______._3�__... ��.. h ... -/S-7 ,ar- - -------------- -- ------ - - Date.--v-j------ - ----- -I----------------------------------------------- SAN - ----------------------------------------•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-9-2M 145446 AT W❑OD 12-54