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APPLICATION FOR SANITATION PERMIT Permit No. ._2`SS_- (Complete in Duplicate) �Z 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. 544, JOB ADDRESS AND LOCATION..._" /0 Lc)e 5 /_ � �/ --- ------------------------ --------•----------------------------------------------------- Owner's Name...... �.__. .. r� A� -------------••---.--------- • ------------- --- -------- ------------------------- Phone---•---------------••-------------- Address--•------------- Contractor's Name �� iS.% ... ..._% G` Phonejx}..__f�-_ iG ---------------------------•--------------•-- Installation will serve: Residence B Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote` ❑ Other ❑ Number of living units: _/_ Number of bedrooms �. Number of baths ---I--- Lot size Water Supply: Public system [_<ommunity system ❑ Private ❑ Depth to Water Table: U_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑---Hardpan ❑ Previous Application Made: Yes ❑ No [O"'-New Construction: Yes ❑ No E3, O TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta ! Distance from nearest weil �_�]/ Distance from foundation___ de 'I`C M to fol---------------------- No. of compartments________ Size_S _-_`L_ . ------------- --• - - ---�_._.-----Liquid depth--- -:`�--- -------.Capacity- Disposal �.�_��_------- Disposal Field: Distance from nearest well_A/0/� - -_ _Distance from foundation___., ---_---Distance to nearest lot Number of lines---------------2%-,--____ r�_Length of each line-------- ------ Width- trench------- length-----._-3 C__ -------------------- Seepage i 1 /, Distance to nearest well___:Y bPA _Distance fr m foundation__-,,-'____.._.Distance to nearest loft line___.�� _/_ [B-Le rAjAumber of pits----------�---------Lining material.__ f_j_C Size: Diameter___-.• ---Depth------, 3- _�_______- Cesspool: Distance from nearest well-_______________ Distance from foundation--------------------Lining material--..___.___-,__________ ❑ Size: Diameter------------------ -------------------Depth----------------------------------------------------Liquid Capacity ------gals. Privy: Distance from nearest well----------------------------------------------___Distance from nearest building ------------------------------------ El Distance to nearest lot line Remo eling and/or repairing (describe:.-___ -_ __ _ _ 1<T �_____ �f� j�/`G _. -------t of-W _Z_ r' 'yf L---- fl'� f._.amu y.=_ -------- _r _ -----------------------------------------------------------------------------------•--•---------------------------••--------------------------------------------------------------•-------------- •----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------- % ---- f C --: A/ ______(Owner and/or Contractor) gy:---- ----- - (Title)--- ---- - - ----- - - -- ------ ----- ------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y�---------------------_-------_------------- Lr► DATE_ ----------•--- --------------------------------- R1 REVIEWED BY ----. DATE__ - ---- ----------------------------------------------------------------------- - BUILDING PERMIT ISSUED. _ A Alterations and/or recommen a ions:_ --_-`✓��1 -, � ---- - ----- - ------ -- ----- - ----------•--- .-------••------------- FINAL INSPECTION BY___________ ---- ---- - ____ Date--------__•-_ ----~ . SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amariean Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Er-9-2M 145446 wrw000 12'54