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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ......��4/ Applica4-ion is hereby made to the Son Joaquin Local Health District for a permit to construct and install the wobk herein.clescr&d.-1 This application is made in compliance wjih County Ordinance No. 549. JOB ADDRESS AND LOCATION..--__ - -- ---- 1 ----- --- --------------- -- Owner' s Name__e____,A,a------ ----- - - --------------- Phone-- ------0_44�2 Address____R,____�--------- -- ------------------------------------------------------------------------------------ -------------------------------------------------------------------- ----------------------------------------------------------- Contractor's Name----P. --------------------•-------------------------------------------------------------------------- Phone---------------------------•-- Installation will serve- Residence ;tmenf House E] Commercial [] Trailer Court El Motel Ej, other 0 Number of living units: --- Number of bedrooms --2--Number of baths A---- Lot size -----6 a X Water Supply: Public system ❑ Community system F1 Private in__Qapfh to Water Table _?-Off. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam [] Clay [] Adobe 4—"Mpan Ll Previous Application Made: Yes E] No [Z--New Construction: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: a---, (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic jank.-. Distance from nearest well-----------------Distance from foundation------------.------Material_-------.---._-------__ " No. of compartments------- ------------------Size--------------------------------Liquid depth---------- --------------Capacity A�ield. I F D' posal Field: Distance from nearest -Distance from foundation----/_,01__.__Distance to nearest lot line.-_--- Number ------- F� of lines-----------0-------- Length of each line_-____--6 -42_f----------Width of french---- T -----A----------Depth of filter material----- __ length----_----At-a-0-------------------- Seepage ength---------At-a-0------I------------- Type of filter material-_--.I 1*e Seepage Pit: Distance to nearest well-------------------------------Distance from foundation_-_------------._-. Distance to nearest lot line--------_----_--_ ❑ Number of pits.---.._--------------Lining material----------- -----------Size: Diameter-------_---_- --------Depth-------------------------- ------ Cesspool: Distance from nearest well--------------.--Distance from foundation ------------- Lining material---------- ------------------------- F-1 Size; Diameter------------------------- -----------Depth-------------------------------------- -------------Liquid Capacity----------------------- Privy: Distance from nearest well--------------- --------------------_-----..-.-Distance from nearest building-----------------------------------_gals. F1 Distance to nearest lot line.------------------------------------------------------- V1 Remodelingand/or repairing (describe]--------------------------------_-.-._ ._-----------••----------------------• --------------------------------------I---------------------------------------------------------------------------------------------------------------------------------------- ------ -------------------------------- ------------------------------I---------------------------------------------------------------------------------------------I----------------------11------------------------------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. (Signed)_.,_.6��--- ----- ----BBY:-------- Y:-------- r - ------------------------------------------------------------(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_(.%%tj _.. --------------- DATE REVIEWED BY --------- BUILDING PERMIT ISSUED-------- ------------ ----------------------------------------------- -- ---------------- DATE ---------------------------------------------------------------------------------------- DATE------ -(Z% --------------------------- Alterations and/or recommendations:-. -------------------- ---------------- -------------------------------------------------------------------------------------------------I-------------------------------------- --------------•------•-•----------------------------------------------------- -------------------------------------------_--------------------------------------------------- -------------------------------------------- --------------------- -------------------------------••------------------- --- ---------------------------------- --- -------------------------------------------------------------- -- ------------------------------------------------------------------------------ - --------------------- ------- ------------- -------------------- ---------------------------------------- -------- ------------------------ ---------------------I--------------------------------------------- "'; FINAL INSPECTION -------- Date.-..1-------_--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 EB.-9-2m 145446 ATWCU1l 12-54