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APPLICATION FOR SANITATION PERMIT Permit No. ...... _f� (Complete in Duplicate) . x Date Issued Y / + Applica-lion is herebymadeto the Sari Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. r JOB ADDRESS AND;LOCATION---------------- -�.IO_____, W grG,trr Owner's Name 1 CC4.__q� 3J'6_� .. ,_. _ e r 6 -- Phone Address................ ----•------ ------------••-------- •---•----••------------------------ ----------- --------- 4 - Contractor's .Name_______________________ --------------------------------------- - - - - --------- ------------- ----------- - - ------- •-------------- ----------. Pone__..----•------------- Installation will server Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _--___._ Number of bedrooms --E.___. Number of baths a_--- Lot size _____________________ i ----------•-------•------------------ Water Supply: Public syste �3fee+: Community system E] - Private'❑ Depth to Water Table -------- ft. Character of soil to a depth oSand ❑ Gravel ❑ Sandy Loam ❑ Cla Loam Y. ❑ Cla y ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIE CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation---------_----------.Material__.______.__._-- ❑ No. of compartments- --------------- ------- Size------------------ ------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well---------------- Distance from foundation--------------------Distance to nearest lot line•._____.----_.._. Number of lines-----------------------------------Length of each line------ -----:------Width of trench------------------------ ----------- ype of fitter material--------..._._.__.------Depth of filter material----___________________Total length---.------ _______._._______._ __ Seepage Pit: RWDistance to nearest well_.__._____-.______Distance from foundation_________________'-.Distance to nearest lot line_-- I] Number of pits----------------------Lining material__--________.___------Size: Diameter____..______..._ -- ----Depth------------------------------- CessRool: Distance from nearest well______________'__Distance from foundation---M!--------Lining material__' e ,-fGy-__-_----_ "�l} Size: Diameter - -5 ---------Depth------�� ------------------ -----------------Liquid Capacity--------------------- ------gals. Privy: Distance from nearest well _______________--,---------------- -------- from nearest building ❑ Distance to nearest lot line_________.-'------------------------------ - Remodeling and/or repairing (describe)________________________ --------- --------}----------••---------------- --------------------- •--------------------'----------------------------------------- 1-hereby 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 regulations of the San Joaquin Local Health District. w { --------------- _------- and/or Contractor) I t Y• ---------------••---•---------------••------------------------------------------------ - -- - ----._Title (PlotEplan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- ------ REVIEWED -- DATE------------------------ - - ----- -------------- ---------------------------- REVIEWED BY_ -t- - - - DATE----- DATE------.Yl�� . 0 BUILDING PERMIT ISSUED.___ _ - - ------------------------------------- --------------------- Alterations and/or recomr�rend ron _-. --------- _- GGcc.�[� ---- -----------1 ' FINAL INSPECTION BY------- - - -- ---- ------ Date....... --Z� 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 Edi---9—yM 145446 ATWO0D 12-54