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APPLICATION FOR SANITATION PERMIT Permit No. ig (Complete in Duplicate)P P P a� �`Y I date Issued -l-- ---n-----5.. Applica4ion 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 wi1�1Cff Ordinance No. 549. JOB ADDRESS AND LOCATIO ------ --------------- ---__.........7VA/ A-- -- ---- ---------------- - Phone---------------- Owner's Name------ ----••---- ------------------------ - Address__. S ------------------------- ---------•------------------------------------------•--•-•----------------------•----------/-----�--�----r------ Contractor's Name----- ----- ---- -•---•-- ----• .----------•- --- - ---------- ---------•----- ------ -----•-•---------------------------------- Phone/,T_�'___!— ------ Installation -—- Installatiion will serve: Residence 6—`Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel ❑ Other ❑ Number of living units: __f____ Number of bedrooms _,?— Number of baths _/____ Lot size ___,.J^Q____ '-____�--_ -�?-_• Water Supply: Public system 9L—Community system ❑ Private ❑ Depth to Wafer Table J7,Pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ar pan ❑ Previous Application Made: Yes ❑ No 2�_New Construction: Yes 6—NO-Fl TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is avaiia6le within 200 feet.) Septic Tank: Distance from nearest well------------------Distance from foundation___________________Material_____._.-_____________- _- /B�,R�S� No. of compartments------ --- -- ------------Size-------------------------------Liquid depth---------- ---------------Capacity----------------------- Disposal Field- Distance from nearest weli Distance from foundation--___/V__"`.__.Distance to nearest lot line----S'_--.-___ Number of lines--------/-----------I-------------Length of each line----10-_'__-- Width of trench._-C.Y___________--------,_- Type of filter material----- 4._______._Depth of filter material_____--S-1� .-.Total length-------- -- --------------------- -- Seepage; Pit: Distance to nearest wello0�0 .r_-__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___-___.__.____________---_____._____..-. ❑ Disfance to nearest lot line-------------------- --------------- Remodel.ing and/or repairing (describe): t---------- -------------------------------------------------------- ------------------------------------•---------------------•-------- •----------------•----••--------------------------------------------- - --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance tate laws, rules a d regulatio s of the San Joaquin Local Health District. 00 r (Signed) Contractor) ---- ---- ------------ ---- --------- ----------------------------------------- an or By:------ -------------- _- • ------. . ---- -• ---------------------------------------[Title)- (Piot plan, showing size of lot, location of sysfem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------- ---------- - - - --------------------------------------------------------- DATE------� --------------------------------------------- REVIEWEDBY-------------------------------------------------- -- - -- ---------------------- -------------------------- ----- DATE------ -------�-------- BUILDING PERMIT ISSUED--------------------------------- DATE. Q ----------------------------------------------------------- Alterations and/or recommendations----------------------- --------pM -- _-_ -------••------------ - V --------------------- ------------------------ ------ ---------- -------------------- -------------••---------------- -------------------------------------•--• --•----�----------•---..._... ---------------•-.-- -------------------------------------- r --------------•------------ - ----- FINAL INSPECTION BY:--- `� Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Streef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWtlob 12-54