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v � GJ APPLICATION FOR'`SANITATION PERMIT '= Permit No..AO� -- J[-.- .__- (Complete in Duplicate) 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 Ordinance No. 549. JOB ADDRESS AND LOCATION.- n� cry----- ---e]-- -+e --------------------------------------••--------------- Owner's Name--- - ---------------------------------------- ------------------------------------- Phone----------------------------------- Address----- `5 ^- ----- ------------------------------------------------------- ---------------------•--•------_---... Contractor's Name Cl r`--y----------------I----`--- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court (] Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ___I___ Number of baths -1..... Lot size .___- ,.4__X___1 .6__x______________________ 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 ❑ 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-,5,j------Distance from rfoundation__/_#-------_ M�a _________________ No. of compartments____�------- --�------Liquid depth---- ---------------Capacity---- -&6-------- Disposal Field: Distance from nearest well_5-_Q...-._Distance from fcundation_LQ-----------__Distance to nearest lot line--us'________ Number of lines_____ --__ .- ---_-Length of each line______--fa-__________-_-Width of trench___ _- 3_ _--________ Type or filter material__ -G .�" g __1_ __D Filter material---1_g.-.- ____-.Total length [�-- ------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lotline----___-__--__- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth......-----_--------------- ---V Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-_____--__-___,___________-_-____. ❑ Size: Diameter--------------------------------------Depth------------------------------------------------ ---Liquid Capacity-------•------------------gals.0 Privy: Distance from nearest well ___-_-__________---------_---------------------Distance from nearest building-____--______-__________________________. ❑ Distance to nearest lot line-- --- - _----------------------------------- ---------------------------------------------------------------------••••-------------------- Remodeling and/or repairing (describe)--------------- -------------------------------------------------------•-----••--•--------•-------••----------- ..� -----------------------•---------------------------•----------•-----------------------------------------------•----•-- ------------------------------•-----------------------------•------------------------------------------ ------------------------1. -----------------------------------------------------------------------------------•-•-------------------------------••----- -------------------------------•---- --------------•------------------•-----------•--------------------------------------•------•----------------------------------•----------------------•••-------------------------------- 1 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 Health District. (Signed)--- - --- -�-'-��-�---------------------- -- (Owner and/or Contractor) By:----------------------------------------------------------------------------------------------- ------- ----------------------------(Title)------------------- ------------------ - -- ------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------- ---------------------------------------------•------------- DATE-----------e----------------------- -•----•--------------- REVIEWEDBY---------- -------------------------------------- - --- ----------------------------------------------------------------- DATE------ ----.- ------- ---------------------------- ------- BUILDING PERMIT ISSUED---------------------------------- -----S DATE------------ --___--- Alterations and/or recommendations:------------ -- ------- --------------------------------------------- -------------------------------------- ------N ................... ---------- --------------------------------------------------------- ---------- -----------------------------------------------------••-----------------------------•------------_----••-•---------------•-•-------- ........ -----•-•--•---------------------------------------------------------------_-------------------------------------------------------------------------------------------------------------- -•------------------------------- ------------- ---------------------•------- -------------------------------- --- --------------------------------••------------- ----------------------------------------------------------------------------------------- FINAL INS�rECTION BY:---`-----1- 'l�C _s -------------------- Rate--1 ----------------------------- 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 E5-9-2M 145446 ATWQno 12-54