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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---./�T_� Application is hereby made to the Son Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance wiA County Ordinance.No.eA59. JOS ADDRESS AND LOCATION_ -- --- --- - ----�----- t.......... ------ Owner's Name.------------- 0- C-1 -- - - - ------------ --------------- ---- ---------- ----------- --------- Phone_Address------&-f-I------- --------- ---------------------- -- ------------------ ---------------------------- ::�c-�------__,5- __ ---.---. ...*....*-------------------------------- Contractor's Name--------------------------61----- ----------_,-.,-•- Phone-----------•----•------------------ Installation hone---------_----------------------- Installation will serve: Residence Eg--Xp_`arfmenf House [] Commercial [] Trailer Court [-] Motel JJ Other El .0 Number of living units: __j---- Number of bedrooms __umber of baths I_ Lot size ----- ____________________ Water Supply: Public system F ] Community system [] Private ET�pth to Wafer Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam layLoamEl Clay [-I Adobe El Hardpan ❑ Previous Application Made: Yes g;--t1'o [:] New Construction: Yes 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--__ _.__Distance from foundation--.- ---.MaterieL-.-- -------- r y_____-9; ___0 No. of compartments------- dep�h----------; -------Eapac!�, Fit Disposal Field: Distance from nearest Distance from foundation-_4P;i�7.........Distance to nearest lot line------ ----------Width of tr ------------------ Number of lines___._______.--------------Length of each line________;;�_ ench--------Z-4! X Type of filter material_ .---Depth of filter material---/,y_{_._____._.Width length-----------7,$7 7----------------------- Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line.._____.___-_____ ❑ ine----------------- 11 Number of pits----------------------Lining material----------------------.Size: Diameter------------------ ----Dept h--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------Lining material____._____________.____.________--._ ❑ Size. aterial------------------------------------- Size. Diameter,-,.----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------- -------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line.-------- ----------------------------- - ---------------------------------------------------------------------------------------------- L Remodeling and/or repairing fc1escribe):------------------------------------------------------------------------------------------------------------------------------------------- ........ ................._...............--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------I-----------I----------------------------------------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) Jg.f---0..�;--- ---------------------------------- -------------- ----------------------------------------------------------(Owner and/or Contractor) Bi-...... ------------------------•-------------------------------------- ------------------ ----------------------------------(Tif le)--------------------------------------------------------- - (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 -9 APPLICATION ACCEPTED BY---------------------------a0ew----------------------------------------------------- DATE_-- ------4_--.7_7-1 REVIEWEDBY----------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED----------------------- ----------------------------------------------- ::----•-------- -- DATE-------------------- ----------------- ----- -- -------- Alterations and/or recommendations:-------------- ------- ....../�------- --------7-_`_i----------- .......... 7/7 ------ ------- --- ---- ----- ----------- -- - --------------------------------- ------------ -----------...... -- --- -------------- ------ -- ------------------- 1117 - - ---------- ------------------------- ------ ----------- ---Xe....... -------- ------------- ----- ...... ----------------------------------------------------------------------------------------------------------- - -------------------------------------------------------- ------------ - --- --- ------- - -------- -------I------------------------- ----------------------------------------------------------------------------- FINAL INSPECTION BY:-___. ---------------------------- --------------- 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 145446 ATWOCD 12.54