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Permit No. .5.......... (Y ' APPLICATION FOR SANITATION PERMIT . (Complete in Duplicate) Date Issued _s A Application 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 com fiance with County Ordinance No. 549. JOB ADDRESS AND LOC T O -.- �o "" �r�� ------ ---------- •--- ----------------------- f Owner's Name----------------- � - Y � ��`-` --- Address----------••----------------- - �fd�. -------- ------------------- ---------- ---.--------••-.. ----------------------------------- Contractor's Name. : Phone__f 'D_.. d installation will serve: Residence ®-'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _Number of bedrooms __ Number of baths -_ Lot size _-_-._-_.7..I'._'.._7c__.__.S_� -------- Water Supply: Public system �ommunity system El Private ❑. Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[l""Hardpa, Previous Application Made: Yes ❑ No 2---New Construction. Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 700 feet.) r eptic a ' : Distance from nearest well-------------- Distance from foundation--------------------Material------------.---------------------.-------------. No. of compartments------- ------------------Size------•-:--------- -------------Liquid depth---------------- - ----Capacity..--------------------- I osal F• Distance from nearest well___----------- Distance from foundation____________________Distance to nearest lot line.---------------- Number of lines------------------------- - -------Length of each line------------------------------Width of french--------.-----------------.-------- Type of filter material-------------------------Depth of filter material-----------------------Total length__.-----------________-------- --. ,ff 1�..____Distance to nearest lot line____9-----__ �{ Seepage P' -.` Distance to nearest well_1`�-4'h-t,.�.-Distanc om oundation___ .__ •^-- Number of pits-----/---------------Lining material -_--._.Size: Diameter-9-3-1_-.----Depth____'2 --`----------------- N 111111 - t Cesspools Distance from nearest well-----------------Distance from foundation------------------- Lining material-_.-____-_.--_.--__.--..--__------- i ❑ i Size: Diameter------------------ --- --------------Depth--------------------- --------- - --------------.-Liquid Capacity---------------------------gals. Privy: Distance from nearest well. ------------------------------ . --------------_-Distance from nearest building------------------------------------------ I ❑ Distance to nearest lot line------------------------------------------------ ------------------------------------------------------------------ Q 6 Remodeling and/or repairing (describe):------ --------------- --------.--------------••--------•-------..__--...--•------------------------------------- i -----------------------•---------------•--I- --------------- ---------------------------------------------- ------------ --- ------------------•------•--------------------------- -•-- ---------- --------------- --------- -------------------------- -------------------------------------------- `v ------- ---------•-----------•------- �`----- ------------- -------•------------------------------------------------------•----------------------------------------- ! hereby rtfy that I have pr pared this application and that f�► work will be done in accordance with'San Joaquin County ordinances, St t laws and-rules nd regal 'ons of the an Joaquin cad Health District. Signed -- ---- an o Contractor) { Grc� - ----- --•__--Title By: . . --- ---- -�----�-- g ( } ---------------------------------- (Plot plan, showing size o lot, location of system in relation t ells, buildin s, a ., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - -. ---- DATE _ - BY-------------------------- -------------------- - - ----------------------- DATE---- . = - BUILDING PERMIT ISSUED----- -------------------- -- -- DATE-.-------------- ---- - Alterations and/or recommendations:--------------- - - -------------------------------------------------------------- / FINALINSPECTION $Y:_. ..r-.�!---_-----�---------'-�="�'l`-�---:--:= Date_...� � ------ ------- ---------------- ---------------- 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 Er--9-2M 145446 ATWOOb 12-54