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rV APPLICATION FOR SANITATION PERMIT Permit No. Y1`� (Complete in Duplicate) Date Issued ----- A%pplica-%n is hereby made to the San Joaquin Local Health District for a permit Ao c %t and_qnstru aIII the work herein described. This application is made in compliance with Count Ordinance No 549 // � f Z" ---------------- ----- - JOB ADDRESS ANPLOCATION---- ----------------------- bj--t---------------------------------- Owner's Name---------t�------ ----------- rte ------------- - ---- Address...... .........f.s�.......V�--Pt ------------- ---------------------------------------------------- ------- -1 - -f-------------------------------------- ------------ Phone Name ----d t-9- / 1------- Installation will serve: Residence [Apartment House ❑ Commercial [] Trailer Court E] Motel 0 Other 11 Number of living units: --/--- Number of bedrooms Number of baths I--- Lot size ------- --"-____f2-.4----------- ----------- Wafer Supply: Public system 0- Community system El Private [-1 Depth to Water Table____ ft. Character of soil to a depth of 3 feet:' Sand [] Gravel ❑ Sandy Loam El Clay Loam 0_ Clay [] Adobe El, Hardpan El Previous Application Made:. Yes E] No 0- New Construction: Yes Z' 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 wehANW-Di'stan—ce Fro-Wfound;fion'- 10-`--------Material-------------------------I-------- --------------- No. of compartments.._Z------------- ----Liquid clepfh--Z3.'.1------------Capacity__.:"1 I ----------------- Disposal Field: Distance from nearest well DIstance from foundation-/101-_r__.-.Distance to nearest lot ]in ---- ---------- Number of lines-------L Length of each line---!7--f I..................Wicltli of trench--,-,/,F0A----- -- f 01 , i". Type or filter material ..._ filter mate ria ----------..Tota en Depth of f' I length___: `_____________-------------- ate Seepage Pit: Distance to nearest well-�J2tvA;'.--------Distance from founclafion---gs---------Distance to nearest !2t line----,6--------- Number of pits.-I---)--------------Lining --Size: Diameter- Depth- ---�-- ---------------- Cesspool.,. Distance from nearest well-----------------Distance from foundation--------------------Lining material--,____._______.____.__________ _. ❑ Size: aterial--- --------------------------------- Size: Diameter---- - ---------- -------------------Depth__:.----------------------------- ---------:---------Liquid Capacity.---------- gals. Privy: 11-VIDisfance from nearest well--'4----------------------------------------------D;stance from nearest building-----------------------------------------' 0 Distance to nearest lot Iin'e - ---- ---------------- - ----- ------------------------------------------------------------------------- 1� Remodeling and/or repairing (describe)------------------ -------------------------- ---- _ --------------------------------- ------------------------------------------------------- ....................•-•---•-------•-••-------------------------------•------------------------ -_ I---------------------------------------------------------------------1------------------- ----------------------- --------------------------------------------------------------------------------------------------------------------------------------I--------------- ----------------------------------------------- -----------------------------------------------------------------------------------------I------------------- --------------------------------------------------------------------------------------------------------------- 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. DAY & NIGHT (Signed)---- --------------Septk-Tenk-Sewive---------------------- ------------------------------ ------ -------------------------- ------.(Owner and/or Contractor) By: 1206 So.Eldorado HO 2-7046 1 ------------------- iviii R ------------------------- ----------------I-------- ------ -----(Title)-----t- -------------------------------- I 4K.Fibillf ,' -f, (Plot plan.-Oshoing size of lof,ioca son o sys;em in relation to`wells, buildings etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -------------------- ----------------------------------------------- DATE----- REVIEWED BY-------------------------- ------------------ ............ ----------------------------- --------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------------- -•- ---- --------------------- ------------------------- --------- DATE------------------------------------------------------------ Alterations and/or recommendations---------------- -------------------------------------------------------------------------------------------------------------- -----------------•-- _-------- ------- ------------ 11--------- --------------------------------------------•---------------- --------------- ----------------------- -------- - --------- --------------- ----- --- --- ---- ------ ----- ----------------- -------- ----- -- -- --------------- --- -------- 5------------------ ---------------------------------- ---------------- .......... ----------------------------- ------ --------------- ------------------------------ ---------- ------- FINAL INSPECTION BY:----------- ----------- ----------------- Date------ ------- ---------'-1------------------------------------ i -SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street f32 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca. California Tracy, California ES-9-2M 145446 ATWC00 12-54