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I lil-li" APPLICATION FOR SANITATION PERMIT Permit No. --___-. (Complete in Duplicate) Date Issued .. . -- ..7 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 LOCATION--- .-,'56`b .5`"------ /D�1---------------------------•---------------- Owner's Name-----'� - --_..... ------------------------------- ------------------------------ Phone------------------------------------ Address...... ----------•------------------------Address....._ T -•-• Phone.--•----------------------- ..---•------------ Contractor's Name------- ---__ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _t_1___ Number of bedrooms -_umber of baths __/--- Lot size ___— ----^-_.Z_,-,2-0-____________________ Water Supply: Public system M—Community system ❑ Private ❑ Depth to Water Table _1�_-_4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe gR. Hardpan ❑ Previous Application Made: Yes-0 No Pd__New Construction: Yes 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__A/0"2Distance from foundation__4 __ -----Material____- C✓ __. _ No. of compartments.____�._----------Size__,,g674�---�_.*;4Liquid depth---- ---------Capacity----- __._. Disposal Field: Distance from nearest well-_A/Oii,_ �tance from foundation---f, ��__ -.Distance to nearest lot line____l��___. Number of lines__________ _______ Length of each line----,__...___._.Width of trench.___ ----- --------- X g r t r � Type of filter material__L��..____! Cbepth of filter material----- length------.'�Z_________________________ Seepage Pit: Distance to nearest well_-j0 _?.-x4,Distance from foundation__-_ _____,Distance to nearest lot line-----_-'67f_ Number of pits-------/.-----------Lining material....�CrC,s Size: Diameter-----�`�----------Depth----- .��----------- Cesspool: Distance from nearest well-----------------Distance from foundation----------- ---------Lining material-------------------------------------- 0 Size: Diameter-------- -----------------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------_-----3 ..............Distance from nearest building--------_- ----------- ❑ Distance to nearest lot line- ------- --------------------------------------••--•---------------------------------------------------------------------------------------- ti Remodeling and/or'repairing (describe]:-r ..... ------------------'---------- ------------------------------ -•..__._._.....-------- -----------•-------------- ............. -•-•---------------------------------------•---•-----------------------------.---•------------------------ -----------•-------------...------------------------------._. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. (Signed) �t-�r�Siz. o� =4 -� -------- ---- - ^~+ --------------------------------- -----•----------------- -(Owner and/or Contractor) By ---------------------------------Ti#le (Plot plan, showing lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------- ----------- :------------------------------------------------- DATE-----�------------------- ---------------------------- REVIEWED BY--------------------------------------------- -- --- ----�-------------------------------------------------- DATE ,.� � - DATE - - -------------------------------------- BUILDING P,E�.RMIT ISSUED----j------------------ ------- a --I---------_---_------------.-r-.-.-_--_---G---.-.-.--•- --------- Alterations and/or recommendations:------ --------y--- ---. ------`------ - ------ ----- YA-' -------- t... FINAL INSPECTION BY:------.. ---------------------•---------------- Date-----.1.-- 1 2 � 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 145446 AVW0oD