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l� I APPLICATION FOR SANITATION PERMIT Permit No. .._ l __..1.__._ v (Complete in Duplicate) "� Date Issued ----- � 3 ii Applical-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. 'I /3 9 JOB ADDRESS AND OCATION----------- ----------�_- - Owner's Name-----_ _ :i----- :-._ -------- ----------------- - --------------- --- ------------- -- Phone Address ._.._ •--------------- -------- Contractor's Name r `-- 5- -- ---.. Phone----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units __�___- Number of bedrooms ._l umber of baths -_1---- Lot size _-__--_�`-__a �--��---- ---•------- Water Supply: Public system Community system E] Private ❑ Depth to Water Table bg� ft. Character of soil to a depth ; f 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[@_ Hardpan ❑ Previous Application Made: Yes ❑ No [R New Construction: Yes IF 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..li PN€ Distance from foundation___ld.-__._...Material___ -- -- ----- No. of com artments___..._ _Size._-__ rr p �~ _X_ --Liquid de P0 . ...Capacity--J'" Disposal Field: Distance from nearest w !1---E O.7-%P Distance from foundation__--_ _---Distance to nearest lot line___j._jOf_ Number of lines-__.__: __+ f Length of each line______-- �------_- Width of tre--n-c--h--._.---.� oType f filter materia_-/ .----,5�.Depth of filter material-------- ---Total length ` ---------------•--- ----- Seepage Pit: Distance to nearest we'll.._/I/01-,X- -Distance from foundation _ l _ fi�_.__..Distancef�to nearest lot line_._-�� -� 216 ® Number of pits--__!-_'~ :.._.__Lining material_ ____.-____/ ize: Diameter-_._.___ _..____Depth S p ---- -- Cesspool: Distance from nearest well_____________,_ Distance from foundation---_-----------------Lining material------.------------------------------- Size: Diameter--------------------------------------Depth-------------- - ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------____----------------------__________..--._Distance from nearest building.__-_____----.__--_____-.___.._ �R ii V} ❑ Distance tb nearest lot line._._________________________________________ v] -0 Remodeling and/or repairing!'(describe):------------------.-_---- --------------------------------------------------------------------- -----•--•----•------- ----------•-•--•-------•---------------•-•------ ---•------------------ --------------------------------------------•-----------•------•-----------•------•------------------•----•--••------••--------------------------------------------------------------------------------------------- I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St e a , and rules and regulations of the San Joaquin Local Health District. (Signed)-------- �---- ----- ---------------------- --- and/or Contractor) BY: L ------------------------- -(Title) ------- ----- P of plan, showing size of lot, Vocation of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------- ---------------- --- --------- DATE----------------- ------------------------------------------- REVIEWED BY ------------------- ---'--------------- -�----- -- -- -- BUILDING PERMIT ISSUED---.-'.,-.--------- SSUED .�.------ -------- --- ---------------------- •----------------------------- DATE.------------------- Alterations and/or recommendations:------------------.._ ----------------- ----•--------------------------------------------------------------- ----------------------- ------•----------------------•------------ ------ -------------------------------- -------------------- --------------- =� --------------------- - FINAL INSPECTION BY:------_ D ate----- l C� 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 g7WOOD 12-54 '