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APPLICATION FOR SANITATION PERMIT Permit No. 1� .. (Complete in Duplicate) 7� 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 ANDL LOCATI ------- X� 1 .Q ---------------- ----------- O �.'--------------- Owner's Name.... I ---------- f �---t-e ----- ----------------------------------- -------- Phone----------------- Address-_.. ......../;? ------------�.......... r r - Contractor's Name Cid -- -5--------------------- ------------------------------------- Installation •-------------------Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f.----- Number of bedrooms _.2-Number of baths .-1- Lot size _-.----2-��4_.1--�--�------------------- Water Supply: Public system -Community system ❑ Private ❑ Depth to Water Table 6_Q- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91._Hardpan ❑ Previous Application Made: Yes ❑ No E_ New Construction: Yes ❑ No Ek TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: k Distance from nearest well__;-.-.-.--.--_-Distance from foundation-------------------- ❑ compartments--------- --Size--------------------------------Liquid depth----------------- --------Capacity----------------------- Disposal Field: —Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line,.------_-----__. ❑ r of lines---------------------------------Length of each line------------------------------Width of trench-------------------------------•--- ' Ty of filter material-_- ---------------Depth of filter material----------.------------Total length------------------------------------------ �Seepage Pit: Distance to nearest wek__ d4-e-Zistance from foundation-.-_/10-f--.--.Distancre to nearest lot 1ine__.�Q /-- Number of pits...... --------------.Lining material -�_ Diameter--- _-..----Depth _*-------.------.-- \ Cesspool: Distance from nearest well-----------------Distance from foundation----------...______ Lining material---_---------.-------_-------___-_--_ ❑ Size: Diameter----__----------------------- ------Depth-------------- ------------------------------------Liquid Capacity- --------------------------gals. t� Privy: Distance from nearest weft---------------------------------------- ------Distance from nearest building-------------------------_---------------, V ❑ 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, Sfafe , 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 APPLICATION ACCEPTED BY -------- -------------------------------------------- DATE------ REVIEWEDBY-------------------------------- --- -- -------------------------------------------------------------------------------------- DATE----- BUILDING PERMIT ISSUED.-•--------------------------------------------------------------------------------------------------- DATE--- ------------------------------------------------------•- Alterations and/or recommendations:_------ -------- ----- ------------------------------•-•---•-----------------------------------------•-----•----------- ---------------------------•------------------------•------------ ------------------------------ - --- - - ------ ---- i--------•--------•------------------------------------------- ----------------------------- � u -----------)'-------16/K � ------- �Y---�-�----------------- . . . ----------------- --- ----- -- - ------ ------ -- --------------------------- FINALINSPECTION BY------------- -------------------------------------------------- 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 ES-9-21A 145446 ATWO0D 12-54