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V y y APPLICATION FOR SANITATION PERMIT Permit No. .ted ll (Complete in Duplicate) �V 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, t JOB ADDRESS AND LO ATI - -- ._ -------•--------------- -------------------------------------Owner's Name------- = ----------------------------------------------- - _.__.------•-------•------ °---- Phone Address---------- Z----- Contractor's Name --r-~�-- Phone.. _ _7 r Installation will serve: Residence ❑. Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/-_ Number of bedrooms__Number of laths l____ Lot size ___,660 _/S2P Water Supply: Public system �_�Community system ❑ Private ❑ Depth to Water Table , ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Dil New Construction: Yes o, --No ❑ t j` Y TYPE OF INSTALLATION AND SPECIFICATIONS: "V (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel1__ ;-0istance from foundation__ --__--.Material_ ': _ �------------ [,� No, of compartments______ -------_.__Size____. d;---X'56._Liquid depth__.___�Q------------Capacity------�� ------- � ' r Disposal Field: Distance from nearest well._Myvt .Distance from foundation__ --____.Distance to nearest lot line--- Disposal of lines_--________/:____ en th of each {ine______ si l .... ---- g �.� �-�~ i Width of trench ----------------- Type F or filter materiaL__.. �______ _ epth of filter mater.ialj$--._-___.Total length___.__.-GS t ---------------- Seepage Pit: - Distance.to nearest well_._ -_J�Q--Distance fro foundation__... S-$----___.Distan efto nearest lot iine_-f�______ �. Number of pits- ��----------------Lining material, _i'uc : Diameter__._- ' --------De Cesspool: Distance from riearest well-----------------Distance from foundation--------------------Lining material--------------.____--_ ❑ Size: Diameter-- --------------------Depth---------------------•---------------- -------------Liquid Capacity-.------------------- ---gals. Privy: Distance from nearest.well._ _ ____ _____________ -___________________.__-__Distance from nearest building ❑ '%Distance to nearest lot hre------ --------------------------------- ------------------------- 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, State I and rules and. regulations of the San Joaquin Local Health District. (Signed ---------- ----- - - --- - ' =]_ = ----- ------- ----•-------------------- (Owner and/or Contractor) B Y. - ----- 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---------- -E___---- -------- ----- DATE------ `� REVIEWED BY--------------------------------------------- ---- --•-------------- - --------- ------- ---------- -- -- - ------------ -- ------------------------------------------ DATE-----------�- ----------------------•--------- BUILDING PERMIT ISSUED--------------=------ ----- -------------- ------ --- •--------------------------------- --------- DATE------.---------- -. -----•------ � Alterations and/or recommendations:------ ----- ? 5 --------------------------------- ---------------------------------------------- -- `----- ------- ---------------•-------------••-----------•---•----�;6.--------------------------- ------------------------------- - ---- G~ f u5--- -------------- ----- --------••--------- ----- FINAL INSPECTION BY:_____.. �'`�s� - •---------------- Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street t 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California m Manteca, California Tracy, California ES-9-2M 745446 ATWCOD 12-54 t