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APPLICATION FOR SANITATION PERMIT Permit No. .24..4 (Complete in Duplicate) / �LL 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 Ordina ce No. 549. JOB ADDRESS G r ! } '... k ----- ------------ Owner's Name---- --- -•-- - ------------- -------- Phone------------------------------------ Address Contractor's Name -- • • ------- ----------------------------'-----••----.'__ d�A_--l_f6.�-7_.. -• - -------•-------•--- Phone_ - Installation will serve: - Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ____ Number of bedrooms ___/_._ Number of baths _ _. Lot size ____ ___________ Water Supply: Public system �. Community system ❑ 'Private ❑' Depth to Wer-Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0, Hardpan ❑ f _-J Previous Application Made: Yes ❑ No [- New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' Septic Ta k: ` gi4anlce from nearest well--.----. _..._. Distance from foundation___________________Material------------------------------------------------- El o. mpartments------------- ------------Size--------•---f------------------Liquid depth---------------- ---------Capacity----------------------- Disposal Field; stance from nearest well________________Distance from foundation-----------__:=------Distance to nearest lot line_______....._.... ❑ r of cines------------------------------- Length of each line-------------------------.-_.-.Width of french----------------------------------- Type of filter material-------- -- Depth of filter material-------------------.----Total length-----------------------------------_...... Seepage Pit: Distance to nearest wail=-_. � Distance from foundation----/-Q_j__--.Distance to nearest lot line__ �.--F.__ RrNumber of pits------- ____________Lining material___ _ r t'Diameter__. _ -` Depth_-_._, -_--______.__--__6 Cesspool: Distance from nearest well------------------_Distance from foundation....----------_._-. Lining material-------------------:_________________.S ❑ Size: Diameter-- ---------------------------- =---Depth----------------------------------------------------Liquid Capacity --------------------------gals. Priv Distance from nearest well---------- ________-----_ _--------------Distance from nearest building❑ ..�_.._ :.w. Distance to nearest' of fine-;-- ----- ------------ ----------------------------------------------------------••-•--------------------- i r Remodelingand/or repairing --------- ---------------- -------------------------------_----------•-----•-----•--------------•-------------------------------- I Q / p g ---------------------------------------------------------------•-------.-------.-....... ----¢------------.......I-------•-----'--------- ---------------------------------------------------------------------------------- ------------- - -----------------------------•-------.... ------------------------------------ ---------------------------------------------------------- ----------- --------=---------------------------7----_---------------------------------------------------------------- 1 hereby ce that I have prepared this applicafion and that the work will be done in accordance with San Joaquin County ordinances, Sf e I s, and rules and regulations of the San Joaquin Local Health District. S - "r (Signed)--- ?` ( caner and/or Contractor) Y' (Title)---- - t B .------ -- Title -- ------------------ ----------- Ag ------ (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- "•----------- DATES ---------------------------------------- --REVIEWED BY--------------------------------- ---- -------- ----------------- ---------±----------------- ------------ DATE---— _ .I BUILDING PERMIT ISSUED--•--•--------•--------------------- -------` ------------------------------------------------ DATE----------- ------------------------------------ Alterations -_-- ----- ------ ---- -- Alterations and/or recommendations:__.__._ ___..._ _ __. _ v_`___ ---��` -_-..__-____ [ ------ --I--- - ------------------------------------------- -- ' - --------=- ---- ------------ - -- ------ r \ z _____ _________`-_....--------------------------------------.-._..... ------ -----------------...-•---..__...------..-----------------• ,.. ---- Date------ FINAL INSPECTION BY:.- I -r- r- y --- --------- 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 ATWOOn 12.54 ,