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r15 / L 5 � / APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applic&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 CouAOrdinace No. 549. JOBADDRESS AND LOCATION - ------- ----Owner's Name- - ------- 1-------------- ----------------- ---------- ----------- Phone.-------- ------------•------------- Addres;s--- r Contrector's Name ---•---•-- ----------••--------------------------------- Phone-o.14' !7z � ,Installation will serve: Residence partment House ❑ Commercial E] Trailer Court ❑ Motel [:1 Other ❑ Number of living units: _ Number of bedrooms ----2 Number of baths .,/-_-_ Lot size ___��__�-.1�fa'._�_______•--------------- Water Supply: Public system ❑ Community system L] Private 01-4Beptli to Water Table_ ft. r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No 06_h1ew Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) $e tic 'Tank Distance from nearest we!!__ ______________Distance from foundation--------------------Material _.____..___.__________.______._-------__._-_..-. No. of compartments-------------------- ----Size---------------•----------------Liquid depth--------------------------Capacity------------------•--•- Isposal Fiel : Distance from nearest well---------- -----_Distance from foundation--------------------Distance to nearest lot line-------.----_---- Number of lines-------------------------------. Length of each line---------------------------.-.Width of trench------------------_--- oType f filter material_______ ______ Depth --------•--- of fil. terial-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest we!!___ _ — -----Dist ce from fo ati n___.,r ......Distance to neaFT lot 11 Y„)---------- --------------- Number ._____ Number of pits-------/------- .-_L' ng mat rial_Ik.Size: Diameter&,Z_ _____.-_---Dep ______________ ` Cesspool: Distance fram nearest well________ ' V, -.----_Dis ce from found 'an-_--______ __Lining material ❑ Size: Diameter---- ---------------------- ---------Depth----------------------------------- ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------_------__---------------------Distance from nearest building---.-_____---_.____.----_----____.___---_. E❑ 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, State laws and r and r ulations of th San Joaquin ocal Health District. (Signed)_.__/yam _ r Contractor) �-L -r -- ------- ----By:---- --- ------ ------ ------ --------- -------------------(Title]_ e- (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------------------------------ -- ---- - ----------------------- - - -- ---------------------------------------- DATEr-� BUILDINGPERMIT ISSUED---------------- ------------------------------------ ----------------------------------------------- DATE----------ff`---------------------------------------------- Alterafii)ns and/or recommendations:------------------------ ----------- ------------ \ --I- f'_ jjj�,� ---------- I ria _` '=-� i v ....k. x't; �� - /�/v 4/(Lf. .Ia 1- _�rt-rr 1 :!7 .w�r..,i�.. .�.w — -------- +. ------------ -•----•-------------- --------------- ------- --------- +, ---------------- - t ----- - _�'.'__:_ _=*_. .:yl.�5-w',.--.� .?'u�+:.=f- r''___. .•�I±�SL. _./S_�_ ---_ -------------------------------- FINAL INSPECTION BY--------------- ri �� -�1----------- Date------S. ---- Z S.1_..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 Es-9-2M 145446 ATWppo 12-54