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5 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ..I{�'_v�_.S.-!'• Applica+ion is hereby made to the San Joaquin Local Health Districtlfor a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_____________________________ _ _ G 0 ,-- /� e� S Owner's Name--------- �1✓Lt-- - .... ' ------------------------------- '- Phone----------------------------------- =�--y' ------------- -------- ------- •---•----•--. . ------ --- -..__.-------- ------------------------ ------------- Address Contractor's Name-' POL-41--t = � ''-� � _; Phone Installation will serve: Residence ❑ Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :: Number of bedrooms ___ __ Number of,baths ---�4 Lot size ------------------------------------------------------------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .vg' ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy`'Loam ❑ Clay Loam ❑ Clay [] Adobe,[&, Hardpan E] Previous Application Made: Yes ❑ No W_ New Construction: Yes ❑ No 19 e TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan tante from nearest well_________________Distance from foundation--------------------Material------------.------------------------------------ ❑ ;o of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_/(/0-7.�_.- istance from foundation____;___- -.-.Distance to nearest lot line.;_.-` -------- . Number of lines---------- ._ Length of each line_____'_-/Wa.____._.,,.._.Width of trench.______ d____r.____________- Type of filter materia_ j..____ -DEpth of filter material-___-�------ __r_Total length_______�L.�____________________� Seepage Pit: Distance to nearest well___/P�"n Distancefrom fouridation______- Distance to nearest lot line-- Number ine Number of pits___.--_x_____________Lining material--e ComDiameter_ _.. Depth( : __..- • ------ ---- Cesspool: Distance from nearest well-----------------Distance from foundation..._.___..._____--Lining material- t__.__.____.______________:__:: Size: Diameters---------------- --------------------Deth_ -------------------------- -----Liquid.Capacity-,_ Privy: Distance from nearest well__ - _________ ____________Distance from nearest building-------------------------------------------- F1 . _______.__.__________________._______.❑ Distance to nearest lot line------------------------------- ----------------•-----•---------------------------------------------------------------....-------------------- Remodeling and/or repairing (describe)---------------------------------------- ------------------•--•-•---------------------------------------------------: ----------------------------------------------------------------••----------------•--------------•---•-•---------------------------------•-•-------------------------•----------- , ------------------------------------------------------•--------------------------------------------------------------------------•_-----•-------••----------------------------------------------••------•--------------------- I hereby certify a+ I have peepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State ws, and rules end regulations of the San Joaquin Local Health District. (Signed)---- - • ----- -------- --------`----- ------- ----- ---------------------- --------------------------------.(Ow r and/or Contractor) $Y: -a2r" ---------------------(Title)------ (Plot ----(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 APPLICATION ACCEPTED BY-----=--------- -- -------------------------y6 :- ;--------------------------------- DATE ---r3 s�6-------------------- . REVIEWEDBY---------------------------------------------------- -----------------------------='-------------------------------- DATE-------------------:-------------------------------------- BUILDINGPERMIT ISSUED--------------------------------- I, -----._._...-- - -•----• DATE------------------------------------------------------------- Alterationsand/or recommendations:--- ------ --------------------------------- ------------------------------------------------------------------------------------•----------- ___________________________________________________________7_______--_-_____.-----.._______.___._____._______.__.________-...-...,______-____._.____________.________.______._____-_______----_____-----__--__-_-..-________._, 1 ___________________________________.___,_----.__-_---..._._....._____-_._.____._..._________..___-_,---------------:------------------------._-....-------------------------------------------------------------------------- ---------- I �I J FINAL-INSPECTION BY:_._._______--._____________________ -------------------- Date--------51 ------------------ ---------------- 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 F:S-9-2M 145446 ATWCOD 12-54