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APPLICATION FO,_. SANITATION PERMIT Permit No. . -_`413$-.--.- t li D l (Compete in Duplicate) 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 AN LOCATIO _ t"I ' --------------------- .�& 14 � Owner's Name--- ------------- Phone_r"V,_:A--------------- -------- Address--.I -------Address--•- -2-'5...... •'- `wti •- --------------•------------------- ----- --------------- r - ... `I ------- Phone ---------- Contractor's Name . --------------- ----------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ /Other f❑ Number of living units: -t----- Number of bedrooms ...-. Number baths ___1___ Lot size ___ -Q.--------------- ------------ Water Supply: Public system ❑ Community system ❑ Private Number to Water Table 4-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @@"Hardpan ❑ Previous Application Made: Yes ❑ No &J'*' New Construction: Yes Nr No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS.- (No PECIFICATIONS:(No septic tank or cesspool permitted if publicrsewer is available within 200 feet.) Septic Tank: Distance from nearest well. 0.____.-_Dista ce from foundationjr_ {ngE Materiala� ---------- Noml, . of compartments-----? ----------------Size_ � �-#_ -� -�-�Liquid eptly- .--..'-: ----------Capacity--•- - ,� AN _4.C,_.-_.Distance to nearest lot line__________ _____ Disposa Field: Distance from nearest well....-_�..._-__-Distance from foundation_ �_ �► � Number of lines----1--------------------------Length of each line---�, -- i Width of trench-----�------------.-- --------- Type of filter material-_R-#-f-_____-_______Depth of filter material---P-.�._.._ --__.Total length______-I:�_ }i Seepa Pit: Distance to nearest well-_,�_I�__________Distance from foundation__A,4r_�` _.Distance to nearest lot lin ` ) Size: Diameter---- N--__._._.Depth----_2n ----------------- "V Number of pits....(_----``___..Lining material--�t-�___---- � 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----------------------.-----------._-_-.-. ❑ Distance to nearest loft line--------------- --------- ------ ----------- -° ----------------------------------------------•--------------------------------------- Remodeling and/or repairing (describe):---- A � ---•---••-•---- •--------------------- ---------------------------------•------------------- ---- -----------------•-----------------------------------------------•----------•-----------------------•--•------------------ •------------------------••---------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed) ' ----------------------------------------------------- ------(Owner and/or Contractor) �Y� ' ------ ------------ ----------------------------••-----------------------(Title) (Plotplan, showing s�f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED.BY------------ - ----------------- ---------------------- ------ DATE .- -;;J-! ----------- ----------- REVIEWEDBY-------------------------------------------------------- --- -L-"---------- -------------------•-------------------- DATE------- � --------------------------••----------- ----------------------------------------------------- BUILDING PERMIT ISSUED----_-------------------- 1 DATE------:I ----t •---------------------- ------------------•--•----------------------------------------------------- Alterations and/or recommendations:__. --------- ------- -- --------- ------------------------------------------------------ - Cf J —--------- FINAL INSPECTION BY:... - ----- - - Date - 7- 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 E5-9 745446 ATW00D