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APPLICATION FOR SANITATION PERMIT Permit No. S3 (Complete in Duplicate) � Date Issued ---.-/:-_J__�-- 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 r . 549. 4,111 �- JOB ADDRESS AND LOCATI N...-..-.--- ----- -- ------------ - �--'- Owner's Name. = ---------- F1 '��'� Phone-- Address.----•-•---•-----------------------Z_;7_4.3----------C'¢ill IC C: ------- Q9 S 4------------- Contractor's Name----------------------------------------------------- --------------------------------------------------------•--- Phone-------------------•---•---------- Installation will serve: Residence �& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. --�-- Number of bedrooms .. Number of baths I--_- Lot size ------- II-f —--------------- Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy LoamX Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E❑ No V New Construction: Yes, No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: - Distance from nearest well-- ..--Distance from foundation_-_---15P.------Mat rial---------------------_----------- No. of compartments-......_2--------------size-- X -X Liquid depth------- ----V--------Capacity-----a-d _--- Disos I Field: Distance from nearest well___ ?. -...-Distance from foundation-_--_w----....Distance to nearest lot line-----_�...... Number of lines--------------- --- ---Length of each line---------�,G__-------.-.Width of trench.___.-_ �^`�-`...-------- Type of filter material-- r_ _ p a g Depth of filter material length 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----..----------.--.----.---___------. ❑ Size. Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___.________.._____-_--_----_ ❑ Distance to nearest lot line------------------------- -- ------ -- ------------------------_----- ------------ ---------------------------------••----- --------------- Remodelingand/or repairing (describe) -----------------------------------•-••-------•--------------------------------------- ------------------------------------------------------- f ! ' --------------------------------- I hereby cerci that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules and regulations of the San Joaquin Local Health District. (Signed) -- -----__§—fr ------------------- ------------------- ---------------------------------------------------(Owner and/or Contractor] By:-------------------------------------------------------------------------------------- ------------•-------------------------------(Title)--------------------------------------------------------------- t (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 APPLICATIONACCEPTED BY-- -- --- ----- - ------- ------------------------------------------------------------ DATE------ REVIEWED BY � �7 I -- --- ------------------------------------------------------------------------------- DATE---•----- -- - BUILDINGPERMIT ISSUED----------- -----------------------------------------------------------•---------------------=------- DATE-------------------------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------- ------------------••----------- ------------- ---------------------•-------•------------------ -------•-----------------------------...-•--•---------------------•-------------------•--•---------------_-----.._.-.-_------- Y : -------------------------------------------------------------= -------------------------------I-------- --------------------I------------------------------------------------------------------------------------------------ --------•-•-----•-------------•------ -------------------------•------------------------------.-.------- -------•-------------- ------------------------------- pk" FINAL INSPECTION BY:.---- - --- -- ---= Dater, SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" St►aet Stockton, California Lodi, California Manteca, California Tracy, California Es-9-2m 145446 ATWDDO 12-54