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! , APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) �" Date Issued _____4_.,7--._,-5- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t e work herein described. This application is made in compliant with County Ordinance No. 549. ` t�1 -------------------- JOB ADDRESS AND LOCATIO f�.tTjOiC}11/j? �1CrE�___L1112 ._ �Owner's Nam j� ----�.hT.14 ----- --- ----------------- ------ Phone_-------~7--'6�-/-------____ Address-------- !_4-.17��--------------------�-�-.---�?------�_�`�----�=��'-----��_CGU•_�tl�i��.�.5-----------------•------------------•------•---- t p Contractor's Name------------------------- Rte'l�1 S C•------------------------------------------•----------------- Phone-------9'-1 4.0-7--___ Installation will serve: Residence W Apartment House ❑]/`Commercial E] Trailer Court [:] E]Motel ❑ Other Number of living units: .../... Number of bedrooms _7__ Number of baths _.._/__ Lot size -----6-S7'_A.... ---—----- Water Supply: Public system ;JL 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,K Hardpan ❑ Previous Application Made: Yes ❑ No g-- New Construction: Yes M 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 t_Distance from fgun a on_/..®..........Material---- - ( No. of compartments__.__ __________Siz �r __ __- quid depth _��--------------- p • y_ ' _ _ �. Ca aat � �• Disposal Field: Distance from nearest well'U- 1Q-74.-Distance from foundati .../5 ___----Distance to nearest lot line..._.____a4_.__. Number of lines______j__.___ Length of each line___®__'_____________Width of trench________Z�"_________._.. r i _rr__-.____ __ (Q Q Type or filter material___-_'Ir _-_Depth of filter material___li"---_______Total length___ " �_______________________ Seepage Pit: Distance to nearest well_-_-__-_______________Distance from foundation....................Distance to nearest lot line_________________ ❑ Number of pits----------------------Dining 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----------------------------------------------------------------------------------------------------------------------------•---------------- 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 la ules and r ulationt of the San Joaquin Local Health District. (Signed).__-----• --- -------------------- Contractor) .� By: (Title} = .Q1 (Plot plan, showing size of lot, location of system in relati to wells, buildi gs, etc., can be p ced on reverse side). *%-a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_________ ________________________ V56 DATE__.___-_._____ REVIEWED BY--------------------------------------------------------------------------------- _------ DATE_---------- ------L --- --- - - BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------_-------------------------- Alterations ------------------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------'------------------------------------------------............ ................. ---••-----.-• ....••-----, ..__Y_` -------- ----•-... _----••------••--••-•-------- 6 -------•-- -------•-•------*4---------•---•---•-----------------------------•----------•--______-------------------------- •_--------- FINAL INSPECTION BY------------- ------------------------"--__----------- Date---------`� �'•S3 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-9-2M 10-52 Revised W-2100