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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued --- This is hereby to the San Joaquin Local Health District for a permit to construct and install the work herein described, 's application is made in compliance with County Ordinance No. 549, ---------- y-_-- ------------------- ----------- ----- ----- ------------------------------------------------ Phone_ -JOB ADDRESS ANDLQCATIONI'l ------14,--------- -- --------------------- Owner's Name--------- �el ------------- ---- ---- PZ -5_--'_-- �,w-2-A---_73 ----Address ----------------- ......... Contractor's Name - ---------------- - Phone_, .`- 7 ------ -- - Installation will serve: Residence [4-"-Apartment House E] Commercial E] Trailer Court [-] Motel E] Other El Number of living units. ---/-INumber of bedrooms Number of baths ./---- Lot size ----- ........................ Water Supply: Public system 2-1*'Community system El Private E] Depth to Water Table 47Q ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam ❑ Clay Loam E] ClayEl Adobe[Hardpan ❑ Previous Application Made: Yes b No P-'--New Construction: Yes F1 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)' Saptic Tank- Distance from nearesf well_________________Distance from foundation--------------------Material-------------------------------------- No, of compartments--------------- ----- ---size-------------------------- ---- --Liquid depth-------------- - --------Capacity�iwell_________________ ----------------------- S rp sposal. F Id: Distance from nearest we�l--------- - -----Distance from foundation_-______---------- Distance to nearest lot line________-__.__... Number ine----------------- Number of lines-----------------------------------Length of each line............ -----------------Width of.trench---- -------- Type of filter material----------------------- -Depth of filter material--- ---- - ----------Jotal length----------------------------------------- # 571 Seepage Pit: Distance to nearest well-----13P1------Distance om.fou dation---13 ------Dis�ance to nearest lot-line line_ _______________ Number of pits.:------/-----------Lining material-. .-Size: Diameter----- -------Depth-___ 3^------------------------------------ E__� - 6Z�110Z, Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material_____.___________-____________-__.. r : _ Size: Diamete ------------------------- --------------Depth---- -------------------------------- -------- --Liquid Capacity-.-.------------------------gals. Privy- Distance from nearest well_-_,____________________________________________Distance from nearest building____._____-__.___:____..______..______._. r-1 r I Distance to near'esf lot line----------------------------•------------------ ------------------ id - Remodeling and/or repairing ( esc I ib :--- re) ---—------ ---- _- .......... --- - ------ /-------- - ------ --- - 7 --------------------- ---------------- I------- - -------------------------------- ---------------- -------- - ------4eta�, ---------------- - - ------- - --------------------------------------------------------------------------------------------I--------------------------------------------- --------------------------------------------------------------ff-------------------------------------------------------------------------------------------------------------------:----------------------------------------- I hereby certify that I have pirdpared this application and that the work will be done in accordance with San Joaquin County' ordinances, State �Ws, and rules and regulations of the San Joaquin Local Health District. _j (Signed)--------------- - -------------__—-----------------------------------------V... ... --------------------------- -- -------------------- __�_ wner and/or Contractor) By:................. -------- . ..... .......... ........ -------------------- -- - ------ --------------------------------- (Plot plan, showing size of lot, location of system in relafi to wells, buildings, etc., can be placed on reverse side). 44 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY' ............. -------------------------------------------------------------- DATE-7Z----------- --- --------------------------- ---- - ---- DATE---- REVIEWED BY-------------------------------- --- ---------- ----------------------- ---- FE---=e. h� BUILDING PERMIT ISSUED---------------------------------- --- - ----------- --------------------------------------- DATE--.-- ------------------ --- I --------------------- - ----------------% ------------ ------ Alterations and/or recommendations_____-- -- ---------------- 64 4j -- 4 k ---------- -------A- ---- -----------------U--1--------- ------- - ----------- ----------- - ----------- .... --------------------------------- ---------- ------------- I . --- ------ ------------------------ -- ----------- --------------- ------- ------------------------------------- -------- ------------------------ -------------------------------------------------------- ----------------------------- -------------------- ------------------------------------------------------------ --------------------------------------:------------------------------------------------------------- FINAL INSPECTION BY:_.____-.--__, -------- ----------- --------------------------- Date.-- - ---------------- - ------ -------•---- -•-----------------•--------•--•- SAN ate--------------------- 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 ATW