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APPLICATION FOR SANITATION PERMIT Permit No- -------7-151 �---- 1 (Complete in Duplicate) Date Issued r r / 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 n compliance with Count Ordinance No. 549. pp dip Y JOB ADDRESS AND OC kON____---..—J0-- .. : 1 �.-j---��-t. . ------------ Phone------------------------------------ Owner's Name------ = J T Address---- Phone _ - = Contractor's Name-----)�, _ - -_-- �11s - ----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court El Motel ❑ Other [I Number of living units: )----- Number of bedrooms _5_ Number of baths .-{___ Lot size __._ .__- x--/ ------------------------- fPrivate ❑ Depth to Water Table�dit. Water Supply: Public system ® 'Community system ❑ Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ❑ Clay Loam ElClay ❑ Adobe Hardpan I— r r Previous Application Made: Yes ❑ No Q New Construction: Yes R_ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publ' ower is available within 240 feet.) t a_ .�.... Septie Tank: Distance from nearest well-_:. istance from foundation-----' --_--..---Material---- - �;�-- - No: of com artments.....- -- -... x.a��--_..Liquid depth.--- Q --------Capacity---fad- -------- ® r t i1. -lDistance from foundation_-_-Zo..---.-.--Distance to nearest lot Disposal Field: Distance from nearest we Length of each line_---�Zf- --- Width of trench.___._-_ - Number of lines-- -------- - --f xr !/ Ul ' Type of filter material.__./ ..__ -------------------------- -W...--Depth 9 of filter material_--.__-/- _ -__.Total len th_____ N4' 'Distance from foun &tion-.-_-_4�--.--Distant/ to nearest lot line_.. -._-__-- Seepage Pit: Distance to nearest weii.� ------ - � ��--------Depth____- 1 e: Diameter___ 1. Number of pits------ material_1�.. _.. --- - - - r r nearest well---------- from foundation--------------------Lining materiel------------------------------------- Cesspool: Distance from Depth ------------------------Liquid Capacity----------------------------gals. ❑ Size: Diameter----- ------------------------- p Privy: Distance from nearest well._-_._.------__-------------------------------Distance from nearest building----._----------------------------------- N ❑ --------------------- ------------------ ---------- Distance to nearest lot Iine.__------------------- ----- ---- -------------------------------- Remodeling and/or,repairing (describe)___________________________________ _____ ---------------------- ---------------------------------------------- ---------------------------------------•----•--------•• --------------------------------- ----------------------------------- ----------------- I------••---•----------- - ------------••----------------------------------------------------•----•---- ------------ I-hereby cer+' hat I have,prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a la and rules and regulations of the San Joaquin Local Health District. . �C1-x-=—�—= ----------------------------- ------------ - -(Owner and/or Contractor) I ------ - --- --- - --- --- ---------- - -- - (Signed) (Ti#1 { ------------------------------------- By:- --- -- - -• - (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 DATE-- --- -- ------------------------------------------------ APPLICATION --- - APPLICATION ACCEPTED BY------------------------ -- -----•--------------------------- REVIEWED BY--------------------------------------------- --------- — _ DATE------------"�---•- -------•------•----...----••------ BUILDING PERMIT ISSUED----------------------------------------- ::=::------.--------------•--------- ------------------ DATE-------------- ---•----------- -� ` .. Alterations and/or recommendations: - - - -----------•------•-----------•----•------•-------------------------- ------ •--•-•--•---- --- - '�.3 ------------ ----•---- -• ------------------------ ------ ------ --------------- ----- •--- - ------ --------- _ .. J --� - � - ---------------- ---------------------------------- ----------------------------------------- �----------------------------------------------- ---------- - - - - ---- -- - ----------------- Date- ------ - - FINAL- INSPECTION BY- '_.------ --- Date_.. -- ----------------- 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-J-ZM 145446 AYWOOO 12-54 -