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,J� y_%� S ,a �. APPLICATION FOR SANITATION PERMIT Permit NO/---- (Complete o. .___$(Complete in Duplicate) .--1_!f • Date Issued - _� . 0/.aC..r'r.. Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 54 ] JOB ADDRESS AND LOCATION____ I_ __ ___.____� /y_ __________ f R Owner's Name---------- Y '!: t'ms's'------`' ? - - -------------- ------ Phone---------------------------------- Address--------------- ---•---Address--------------- --' - ------.---------------- Contractor's Name____ --------- --- f Phone--------------- ------------------- Installation will serve: Residence 1"' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E F Number of living units: _1___ Number of bedrooms vF-. Number of baths ._f___ Lot size ___ fit_ _ __ _ ________________________ Water Supply: Public system 93-1"Community system ❑ Private ❑ Depth to Water Table'X07 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 'Hardpan ❑ A . Previous Application Made: Yes ❑ No 0' New Construction: Yes ❑ No 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_/k- Distance from foundation__------___Material__.ir_ .. ._-________--__�___- I p ----- Size--- No. of compartments �. . �____, _ ___Liquid depth___' Capacity---lyra_____---- Disposal Field: Distance from nearest well-At-7- Distance from foundation____ ._.Distance to nearest lot line---f14..______. Number or lines------------ ------------------- Length of each line------7_—: �...........Width of trench----W-y--f------- ------.-._ Type of filter material_ A', Depth of filter material_.,`_,'...____._Total length-------- -s_____________________ f � Seepage Pit: Distance to nearest _Distance from found tion____, ..__ ------ to nearest lot line----- 'el ®' Number of pits-------./------------Lining materialC_4_l; 4s;. ize: Diameter___-_ ---- Depth...... Cesspool: Distance from nearest well----------------- 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):______. _ ----------•-------------------------------------------------------- ...........................................................'___...------- : C___-__ ------------._--_____-_--___-_----._________-__..___-__.______.__ ____________________________ __ __-__ _-- .. .._________________`._____-___________-_____________________.________.___._______._________.________.__________---____._________________..-_-___-_-__._.._ 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 rules and regulations of the San Joaquin Local He(�Ifh District. "3 (Signed] kr�� ,� --. - ------------------------------------(��r Contractor) By:_---------------------------- - .W� 9:��&---------•-----------............................(Title]---- 1?� �' ,�,�"off' -- ------------- r (Plot plan, showing size of lot' ocation of system in relation to wells, buildings, etc., can be placed on reverse#ide]. FOR DEPARTMENT USE ONLY REVIEWED BY- ------- ------ --- --------- ---------- - - ----------- --------------------------------- DATE- APPLICATION ACCEPTED BY. __--- -- DATE-------- ----------------.--------------------------------- BUILDING PERMIT 15S6E6 ------------------ ------ DATE .... Alterations and/or recommendations:-----------._--------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------------------------- ----•----• -•----------------------•----------•-- ----------------------------------------------------------------------- N i� zg FINAL INSPECTION. BY: -------- ------- --------------------------------------- Date Date------�1l' ------------------------------------------------------------------------ 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-5 145446 ATWOoa