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h / � APPLICATION FOR SANITATION PERMIT Permit No. Ffl (Complete in Duplicate) // Date Issued __.'r�l_.�.!_��` 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. JOBADDRESS AND TION... �/D- ------------ --------------------•----------------------------------------•------•---------------- ef Owner's Name-----------✓ /--------- - - -- ---------------------------- •----- -------------- -------------------------.-...-------------- Phone------------------------------------ Address---------- �i e/4 - ...- -----------------------------------------------•----•-•---------------------------------------..----------------------------------...--------•---•---------------- Contractor's Name--.-------, 7 a._'-- ' -----• - -------------------------------------------- -------------------------------------------- Phone----------------------------------- Installation will serve: Residence [+Apartment House ❑ Commercial ❑ Trailer Court ❑ MotelP Other ❑� Number of living units: _-.�__ Number of bedrooms __l _-_ Number of baths - - Lot size --._. __---x---iyp-------------------- Water Supply: Public system ❑ Community system [I Private �epth to Water Table -------- ft. Character of soil to a depth of 3 feet: S;�New Gravel [I Sandy Loam E] Clay Loam E] Clay E] Adobe 2/HardpanF]Previous Application Made: Yes E] No Construction: Yes P"'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--_ Distance fr9m foundat-oy�__-_.-/0--__-_.Mat i4____ ______ ._. ______.._ __ •, } p [�] No. of compartments-----.--- ----_Size------f- �_SL__. _fE'Liquid depth--------------------------Capacity____-D�d--- ---- DisposaI Field: Distance from nearest wekl_�__-'Distance from foundation.-jj__Ap___.__.Distance to nearest lot line_____ _________ Number of lines-------------�_-__.-..__--__.___ Length of each line__-.__---sPa. ��----.Width of trench.____-_ ___�_" th of filter material----.--.�.F.._._ j--®---------------------- Seepage ` ______-_.__- ' Type of filter material._.�a___. ___ _ p _.Total length_____________V Seepage Pit: Distance to nearest well..--------------------Distance from foundation-------------------.Distance to nearest lot line--.-------------- El Number of pits----------------------Lining material-----------------------Size: Diameter.----------------------Depth-------------------------------._ V Cesspool: Distance from nearest well-----------------Distance from foundation -------------------Lining material------------------------.---_---.---_ ❑ Size: Diameter--------------------------- --- ---- -Depth-------------------------------------------------._Liquid Capacity- --------------------------gals. �j Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building.__._._______.________________.._-.._---_. (/O� ❑ Distance to nearest lot line---------------------------------- --------------------------------------•-------- -----------=`-•-"` l Remodelingand/or repairing (describe):-- ------ ---------------------------- ------------------------------------ .-----•--------•-•------------•----------••-------------------- --------------------------------------------•----------•---•--•-------------------------------•-----••----------------•---------------------•-------------------------------------------------------------------------------- ----------------------- ----------------------------• ------------------------------------------------------------------------------------------------------------------------------------------------- -- I hereby certif h t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5t a sand r I and gulations of the San Joaquin Local Health District. • (Owner and/or Cantractorj (Signed I ---------- - -------••--------------- -- _t ---- ------ -- ----- --------------- By - ------ ------ --------- ---•--------------------------------------------- ----------------------------------------- (Title)- �� ---• - ----------------- (Plot plan, sho in 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.--- ---e�� --- ------------------------------ ------------------------------- DATE------- - - - BULID NG PERMIT ISSUED------- ----•----------- ----------------------------------------- --- -- ------ DAT --------------------------------- `S�"+S."-r- Alterationsand/or recommendations------------- - ............................... -..-----------------•--------------------------------------•--------•--------------------------------------- ---------- --------•---------------------------------------------- ---------- --- ---------------- --------------•-•---- ------------------------------------•-•••-------------------------------------------------.----- --------------------------------- -- ------- -------------------------------- ---------------------------------- -----------------------------------------------•:----------------------------------- ............. -----------------------------•------------------ --------------- - ------------------------------------- --------------- ------- ----------------------------------- ---------------------------------------•-----•-- FINAL INSPECTION BY:.... Date------------- ---------� �- -5------------------------------------ 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 E$-9^-ZM 145446 ATWOQ" 1z-s4