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Permit No: _ 7--- APPLICATION FOR SANITATION PERMIT -/-5/ (Complete in Duplicate) Date Issued .��.�_!._�+ Applicaa-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 in compliance ith Coun• Ordinance No. 549. , E f �fI O 1k JOB ADDRESS AND LOCATION= .' .7? --- =' =` Owner's Na � � - ----------- Phone-------------------------------_-- ---------A------ .l �- �....-_•------� -- ----- -----------------------•------ ---------- ----------•-------- Contractor's Name--- --- - ---- ---- - ---- -----------------------------_------------------------------------------------- Phone Installation will serve: Residenceartment House [�)) Commercial ❑ Trailer Court ❑ Motel ❑ Ot/hpr f Number of living units: --- __ Number of bedrooms .t5 ._ Number of baths __/____ Lot size ^_ _ A Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo;�No Clay Loam El Clay E] Adobe C] Hardpan E]Previous Application Made: Yes ❑ No � New Construction: Yes ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi�seWer t available within 200 feet.) C f/� Septic ank: Distance from nearest weIIc 0� 15istar�c fr fo nation{.:C/______- Mate t I__-__-_____ ______ Ca adt ` No. of compartments_-_------. _ _Size_ -__•___Liquid depth__..____ 1i p y___ Disposal Field: Distance from nearest we€l `' Distance from foundation ------ -_ _. Distance to nearest lo-li d_f*___._`:��€` ' [ Number of lines_________ Length of each line------- fsil ;, Width of trench___._____ ��.___________Type of filter materie, pth of filter material-------- -__'____Total length______-_-- _ __________________ Seepage Pit: Distance to nearest well--_.__.__'__..______Distance from foundation___________________Distance to nearest lot line__________-_..__- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_-.--------------------_---_-..._ Cesspool: Distance from nearest well----------------- from foundation--------------, --.Lining material--------------------___._..... ________ ❑ Size: Diameter----------------------------- -------Depth--------------- ---------------------- -------------Liquid Capacity-.-------------------------gals. Privy: Distance from nearest well------------------------------------------- ----Distance from nearest building--------------------------------------_-- ❑ Distance to nearest lot line-------------------- ------------------------ •-------------••---------------------------------------------------------------------- Remodelingand/or repairing (describe):------ ------------------------------ ----------------_-------------...---------•------------------.------------------- ----------•--------------------- ¢! -----------------------•---------------•------------------------•-----•-------------•-•-------------------------------•-------------••-•-----------------•------------------------------------------------ r --- .......... ----- ----------------------- -----• --------------------------------- --------------------------------------------------•----------------- ---------•-----------------------•------------ I here6y 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 regul +ions of +he San Joaquin Local Health District. (Signed) t7 = r - ------------- ------------------- (Owner and/or Contractor) `' d Sy:-------------------------------------------------------••------------.--- -------------------- ---- -• (Tifiie) (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 �s APPLICATIONACCEPTED B -------------------- -- ------------------------- ---------------_----------- ----- DATE_14��----------------------------------------------------- REVIEWEDBY-------------------------- --- ------------ -------- - • ------------------------------------ DATE--" BUILDINGPERMIT ISSUED------------------------------------------ --------------------------------------------------------•-- DATE-- Alterationsand/or recommendations:----------------------- ---------------------- ---------------------------------------------------------- ---=---------------------------------•------------ -----------------------------------------------------•---•-----------------------------------------------------------.....-----------• ------------ .....------------•-.----------------------------•--------•--------------- le-1 FINAL INSPECTION BY:.... Date.... f-� `-�_- 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 ESS--•9-2M 145445 ATWCOD 12-54