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APPLICATION FOR SANITATION PERMIT Permit No. LE--- -7- (Complete in Duplicate) bate 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 CATION______11A_----- Owner's Name - --------------- ------------------ ----=" - - 5=3.� --. Phone-// --- Address-- _:._ --------=----------------------------------------- Contractor's Name------------------------------------ -- = Phone- -96x_7 ---- ----------------------------- - ------ Installation will serve: Residence [Apartment House ❑ Commercial.❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --�___ Number of bedrooms _�_.. Number of baths _�__- Lot size.__._Jt_0_-�/�-/!)O-�------------- Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table .90 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[-Hardpan ❑ Previous Application Mader Yes ❑ No 0� New Construction: Yes ❑ No P?' TYPE OF INSTALLATION AND SPECIFICATIONS:: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) epfc Tank: Distance from nearest well_________________Distance from foundation------------------- Materiai_.______.____--___-__________-_-_.____.___----. : . No. of compartments--------------------------Size--------------------------------Liquid depth----------- --------------Capacity----------------------- spo Field: Distance-from nearest well..---------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines------------------------------------Length of each line-----------------------_......Width'of trench-------•--------------------------- Type of filter material------.-------------______Depth of filter material-------------------------Total 'length_-_-__________.___-_-__.______-_____--___. t ' ' !` it: Distance to nearest well-_/Q:a_-14,0 -_Distance orr� f undationf��....__�.Dista��e to nearest lot line___-__.______ Number of pits.!.___ __.._-----Lining material_:.___Size: Diameter--- - ------------Depth_.- 5-_---_____.__________. Cesspool: Distance from nearest well-----------------Distance from foundation........._......__.Lining material--------------- El Diameter -----------Depth---------------1 ----------------------------------- -Liquid Capacity- --------------------------gals. Privy: Distance from nearest well_---_- ------------------ ---------------------- from nearest building-------------------------.__------._--_._. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------- --------- Remodeling and/or repairing (describe) ----- --------------- --•--------- -------------.....--------------------------•--------------------•-- ----- - t ----------------------------------------------•--••--------------------------.---------------------------------------`------•---------••---------•---------------•----------------------------------------------------------- F ------------------------------------------------------------------------------------------------------•---•----------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ -------------------------------------------------------°----- --------------------•------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat laws, and rules and regulations of the San Joaquin'Local Health District. Si ned �__ " ( gP A.A�l -------------- ------- y ------- Owner and/or Contractor) - e---A------------ By:------------------------------ - --- � __ {Title) --------------------------------------------- (Plot plan, showing size of lol, location of system in relat' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- /------- -- ---•----•------------------------------- DATE -- REVIEWED BY--------------------------------- -. --.. -- - - -------------------------------------------------------- DATE-- -r BUILDING PERMIT ISSUED._.._--- `---------- --•- ------- DATE----- -------- -� Alterations and/or recommendations:----------------- -------------------------------------------------------------- ---------------------------------------------..----------------------- I ---------- --------------------------•-------------•----.-•-- ..------------------------------------------•--------------------------••----------------•---------- --------------•--------------•--------- ------ -----------------------------------------------I-------------------------- ----------------------------------------- ----------------- --------------------- --------------------------------------------------------------•-------•----------- ------ ------------------ FINAL INSPECTION BY:_" J) , -- ---------------- Date_.. -. _ -..._ �,C J. - ------------------------------------------- SAN ----------- --SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street. , 3. 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Fr-9-2M igsgq5 aT w"oo 12-54