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p` APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate � Date Issued Application 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 ith County Ordinance No. 549. _.� oB A _. - J -ADDRESS-AND LOCATI_ON ' +-:--_-marl---- Owner's Name__d--j-__a1.-de° - ,�p_p t[ Npr/'__. T a�P . > ------ s It U --- -F-f- Address ?----A r- Contractor's Name - .�� -----------------""------- -- ----- -------- ------------ Phone-_/*436?-•-6 5-1 07 Installation will serve: Residence [[�partment House 0 Commercial ❑ Trailer Court ❑ Mil ❑ tier ElNumber of living units: ---/__ Number of bedrooms -c5--. !- _- Number of baths .__ __ Lot size ___ ,.� -1 ---------------•-------------- Water Supply: Public system ❑ Community system ❑ Private �ep}h to Water Table __".r'�__oft. 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 [a-11qro E7 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_ ©_f�--Distance from foundation_ __ Material �� No. of com artments-_ -_-- y[ � �r " ---"- -------- -- � p --Size-� ' ---Liquid depth_6,-.3-- ---- ---------Ca acit .1 fid' 7�•� p y f"119111 _ Disposal ield: Distance from nearest well_6'6_'___Distance from foundation---ZQ..........Distance to nearest lot line_-__0er__, Number o: lines___."/.......__ Length of each line of trench-_Zc.yL'1 --- ----- i tf �, --------- N v Type of filter material__ --/,_- k...Depth of filter material_-- Ax _. - -`92-" �5 Total length------,�o�----------------------- eepag Pit; Distance to nearest weIL.�QQ----------Distance f m foundafio /�t n��..-_-----.Distance- o nearest lot line... Number of pits---I-__-___--------Lining material--- o -----• Size: Diameter--- �e t --------- ------ -------------------- C Y Cesspool: Distance from nearest well-_______--______Distance from foundation----_-_---_____--_,Lining ` r ❑ Size: Diameter t Depth ---------------------------------------------Liquid Capacity-------•------------------gals. Privy: Distance from nearest well---_-------------- _-------------------------- Distance from nearest building ❑ Distance to nearest lot lire--------------____-------------------- ----------------------------- Remodeling and/or repairing (describe)______________________- " -•-----•-------- -------------------- •-•------------ ------------- --•----- -----••---•----------------•---- --------------- ----•----- = � - ;--,------------- -------------•------•-------------- • -----------•-------------I------------------------------------------------------------- -----•---------------- I hereby a tify that I ha4,,',pcepared this application and that the work will be done in accordance with San Joaquin County ordinances, at laws, and rules:: nd regulations of the San Joaquin Local Health District. (Signed) x ' -- ---- ---- - ------ ---------------- ------------ - ----------- ----- 13y:. � ontractor) '= - -- - -- --- - - --------(Title) = '�`.m r►' ---- (Plot plan, showing size of lot, location of system relation to well buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY W APPLICATION ACCEPTED BY_ . .-.-__-_-.- -_-- - ' -- ------------------------------------------------------ DATE_ REVIEWED BY. -- -------------------- ---„ ---- - -- ----- --- ------- -- DATE - ` BUILDING PERMIT ISSUED =-i------- -- ------------------------ - Alterations and/or recommendations:__r 11�•._____--_------------------------------ •----- DATE----- ----------------------- --- .z ------------ -----------•---------------------------' ------ --••------------•----------- - -------- ----a--5---- ---- _F1NAL INSPECTION BY----- --------••--- Date_.-_�_ --- �- _ - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California l Lodi, California Manteca, California Tracy, California ES. 9—ZM 145446 ATWOno 12-54