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APPLICATION FOR SANITATION PERMIT Permit No. ..... _3a.3 (Complete in Duplicate) 1 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 AND LOCATIONS_/_4.---------450--- - ---- -- •- J .r - Owner's Name------- Phone Address........• ...------- Contractor's Name t" --------------------------------------------•--------------------------------------------------------- Installation.will serve: Residenceffartment House E] Commercial F] Trailer Court E] Motel El Other El Number of living units: ---1- Number of bedrooms -2— Number of baths I-_-_ Lot size ____^�Q _}C_:_I_..Z- r`___ Water Supply: Public system 6—Gommunity system ❑ Private ❑ Depth to Water Table 4112 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe+-M—arl3pan ❑ Previous Application Made: Yes ❑ No [ -_^ ew Construction: Yes o TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Tank: Distance from nearest wel Septic p Io�_C.-Distantefrom foundation---10__ _ ......MateriaI___ _________ [4r No. of compartments----�-------------SizeS.i(---X__ d---Liquid depth.... .--------.-Capacity____ 5 ---.• Disposal Field: Distance from nearest well y.K__Distance from foundation----fig.........Distance to nearest lot line._.,f9 '.__. [ � Number of lines__---.-.-_ -----_... T material___- __-�e-_ - Dep U- Length of each line--.�49------__-__----_.-.Width of trench.--� !!.___...._..__.- o I Type + __-----.Depth of filter material---A?..._..__.._Total length___----.7 _'filter Seepage Pit: Distance to nearest well__- .,----Distance f om foundation_-___-;x4._'.___.Disfance to nearest lot ---- Number of pits..- -__/.......---_-Lining material___ ------- -----Size: Diameter-_3.?."..----Depth. .--------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material---__._-_----_--..-_.___-------_-_ Q ❑ Size: Diameter -----------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building..-.-...--_-_-.--------_-_---_._-_-_._-__ ❑ 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, Statelaws, and rules and regulations of the San Joaquin Local Health District. (Signed)--- -rte - -------- --------------------------------------------------------------------{r Cwneontractor) By:--- ----------------------------------------------- -----(Title)----------------------•---------------------------------------- (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--------------------------------------------- --.-.----------- - -- --------------------- ---------------------------------- DATE--------- ------------------- BUILDING PERMIT ISSUED - ---------------------- -----• DATE-------------- ---7!1;N Alterations and/or recommendations ----- ---------------------------------- ----------------------- --------------------------------------------------------------------------- --------------------------- ---- -------•---------. .. r------- ------------ --- ------•--•---------------------------•--•---------------•-- ------------------------ -------••. _ -- 6 C, ------------------------\-- ----• ---------•-----------. . ------------------------------- ----- FINAL INSPECTION BY:--�-L ..,= ---------- --------------•----- Date----�'. a U 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 ATWOOO 12-54