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0 APPLICATIONt� FOR SANITATION PERMIT Permit No. _7 (Complete in Duplicate) w Date Issued ---- x_47 s Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work erein described. This application is made in compliance with County Ordinance No, 549 ADDRESS AND LOCATION.. JOB A � -(� `� ./. ._... / �� 1----- -- a_ T: u a _ � :.. Owners Name" -- ---- Address----------------------- Contractors Name............................ ------------------- - --------------------- -- ----------------------------- --- -------- - ---------- ---•--- --------- -------------•-------- Phone---••-----------------------•-----• Installation will serve: Residence ❑ Apartment House [D Commercial E], Trailer Court E] Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ------- Number of baths ----- . Lot size ------------ Water .--........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❑ Hardpan ❑�Previous Application Made: Yes ❑ No ❑ :1 Now Construction: Yes ❑ N~o ❑ � 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______________`__Distance from foundation-------------- ElNo. of compartments = ---Size-------•------------------------Liquid depth...------------ - --------Capacity-, Disposal Field: Distancefrom nearest wail----------- -----Distance from foundation--------------------Distance to nearest lot line---------------- ❑ Number of lines-----------------------------------Length of each line----------------------------..Width of trench.----------------------------._-_-- Type of filter material--------------------'...Depth of filer material--------___------------Total length--------.-----_-_--- Seepage Pit: Distance to nearest well..................._-Distance from foundation--------------------Distance to nearest lot line._..._-...... ❑ Number of pits......................Lining material----------------------- Diameter.__......- k -------Depth------ -------------------------- �. Cesspool: Distance from nearest well-----------------Distarice from foundation--------------------Lining material-.._._ - - --------------_El Size: Diameter------ -�-- � Depth- ----------------------------------- -------------Li Liquid Capacity ...-_.-... 2 -----gals.Distance from . nearest we --__- �_�---------------------Distance from nearest building... LSA Td d s Distance to nearest lot line '� �y ----..... Remodeli g a or repairinq (describe):----------------------------------- .........-- ----- - + f -----6-e --------� -- ----(�[---cra ..~------•-• ------- ------------------------ --------------- 'k v '_€� L --------- ---------- ------_ .. ------------------------ A�par ">•=�---- - '�-�--��.�.-----------------•-------------------------.---•-------------------------- --------•------• --------------- t hereby certify t at I havthis appliL'ation and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and �nfan Joaquin Local Health District. (Signed).-•- - - - -- ------ / Contractor) --- --- ---------- - •---------------- ---------------------------------{Owner and/org By:t---------------------------------------------•--- Title Pot 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 BY---------------- -------- ------- - ------------ ---------------------- DATE---------- ---// REVIEWED BY----- -- t {;j-.. ------- -- ' - - -- ----- - - ------ --------------------------------- --- DATE ------------ --BUILDING ------------- ------------------------------ - - PERMIT ISSUED------------------ -------------- --- --------- DATE----------- -------------- ----------------------------------------------------- --------- •--------------•------ Alterations and/or recommendations:..................... ------------------------------ ----------------------------------- ------- ---------•------ FINAL INSPECTION - --------- Date--------- - --------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 306 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWop" 12.54