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APPLICATION FOR SANITATION PERMIT Permit No. .. _ -_: }' (Complete in Duplicate) /A 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 incompliance with ounty Ordinance No. 549, JOB ADDRESS AND LOCATION :- "s" - ----------------- N _ -------- Owner's Name' r FF -t%�i1 -;"9�, A -"----- - -A Address--------. �_,__�.:.r__-_._�-� -� _.�f�_�,��.f�. = � „� one ------------------------------------------------ 1Y Contractor's Name " :- - •----------------------------------------------------------------- --------------------- -----•-------- Phone-------_--------------------- Installation will serve: Residence` Apartment House ❑ Commercial ❑ Trailer Court ❑ �rrMotel ❑ Other ❑ Number of living units: 1- Number of bedrooms A--- Number of baths J_._ Lot size _____/"►f�--- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy Loam ❑ Clay Loam Clay Adobe❑ HardpaIn Previous Application Made: Yes ❑ No / New Construction: Yes Rj/No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS:(No septic tank or cesspool permitted if public sews is available within 200 feet.) Fr /� I Septic Tank: Distance from nearest wellri'___ _-__Distance fro fou bona.?�____.._Materal_ "_yNo. of compartments.---- . 'Size1- •- ------Liquid depth--.--_---�------------Ca acit -- -- �p y Disposal, Field: Distance from nearest well _ stance from foundation_10_-__�?�`Distance to nearest lot rline,_.� ® Number of lines__________ ___ --- -------- of each line-------------- n _.____..Width of french________.• ' ------------- Type8 -- k of filter material._._ .A----- Depth of filter materiaL___...>�_ _ __--.-Total length____________ _ + -. ---------------- Seepage _-____- �� y ------ Seepage Pit: IDistance to nearest well_____________________Distance from foundation--------------------Distance to nearest lot line--___._.________ r ❑ Number of pits----------------------Lining material.-------------------- Size: Diameter--------------_- - ---Depth---- --------------------------- 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 ❑ Distance to nearest lot line------- Remodeling and/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 rruulfes and regulations of the San Joaquin Local Health District. (Signed) �- I '' j `�� --- ---------------------------------------- --------------------(Owner and/or Contractor)- t {Title)------------------- ---- -- - ------------------------- (Plot plaO&owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYC - ------------- --------------•--------------------- DATE_ REVIEWEDBY----------------------------- --------------------------------------- DATE_~------------- ------------------------------------ BUILDING PERMIT ISSUED---------`? ---------------------------------- ----•---------- ----------------------------- DATE---- .-------- -------------------------•-------- Alterations and/or recommendations:- "---------------------------------------------- --------------- il_--19:_ ----------- �t to e,I.- .�sli1_jic 2G ---------------------------------- ------------------ 411f ------------- ---------•- -"------------------ _-�G -. �- ^+G ---------- ----------------------- -- r FINAL INSPECTION BY:-- 5------------- ---------------------------- Date--- .'�---- 1 i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, Cplifornia Lodi, California Manfeca, Californiad Tracy`, California ES-9-2M 145446 arwooa 12-54