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_ —7-7 . APPLICATION FOR SANITATION PERMIT Permit No. _.;_ � '`---- (Complete in Duplicate) Date Issued `i 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 in compliance with County Ordinance No. 549. �- JOB ADDRESS AND LOCATION---- � -.-------- fes. r .L' 1 --------- Phone--/--------------------�---- ---------- Owners Name------------- - --76 ---------- - �I -------------------- Address--------- ---------------------------- - ----------------------- Phone- contractor's -------------------- one Contractor's Name----- lfs 4 t$ s j Installation will serve: Residence Apartment House F1 Commercial ❑ Trailer Court ❑ M I 1-1 Other [I 1} Number of living units: _---- N er of bedrooms I— Number of baths I----- Lot size .----------------0.--X---_/___-Z_V---------- Water Supply: Public system Community system [IPrivate ❑ Depth to Water Table,T_. ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam [I Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank:y `Distance from nearest well----- ---------Distance from foundation----.--------------Material-----_-----_------._-.__--------- ., � o. of compartments------- Size Liquid depth Capacity.. Disposal Field: Distance from nearest we€i--------_-------Distance from foundation---------------.....Distance to nearest lot line._-------_--_--- ` Number of lines--------------------------------.-Length of each line----------- -----------:-----.Width of trench----------------------------------- l� Type of filter material-______ ______________ D pth of filter material----------.___--e----Total length-____--------.-.----------_f�_- 0 - Distance fro fou ation-.1a-_-- ----Distance to nearest lot line----------------- � Seepage Pit Distance to nearest well- G ' Size: Diameter-_--3 --------Depth------ _T-of pits-..-S✓/_--C--------Lining materiaL�c- . Cesspool Distance from nearest well----------------- from foundation------------------- Lining material----------------.-------------------- ❑ Size: Diameter--------- ---------------------------Depth--------------------- ---------- -----------------Liquid Capacity------- .------gals. l Privy.. Distance from nearest well------------------ ----- _'---.---Distancee from nearest building.----.-------.__---:--_-----_-.--.-_-----. ❑ Distance to nearest lot line------- - ----------- ------- ----------------------------------------- --------------------------- - Remodeling and/or repairing (describe)--------------- -- ---- �� --- ••-- N ------6----- _A------- -------- - ------ t--------- ----- - -- -- E I 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 regula . ns of the an Joaquin Local Ftpalth District. . Contractor) ----- er and r (Signed) ----._ ---------------------------- ---------------------------------------------(Tiffel---- l -- --- --- ---------------- -------• • ----------- -- ` (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I EI' FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----- ---------------------------------------------------- DATE----- -------------------------------------------- REVIEWEDBY---------------------------------- DATE •---------------•------- BUILDINGPERMIT ISSUED------------------------------ ---�------------------------ ------------ --------------------.- DATE. Alterations and/or recommendations:.-.------ ------ ------------------------------------------------- -- ,I .................... i- ----- - ----•-- --------------- --- --- ---- -------------------- ----- ------------------------------------------1.------------------------------------------- --------------------------------------------------------------- --------------------------------------- ------------- -------------- Date_. r s---------------------- FINAL INSPECTION BY------K_1�---- -------------------------- - E+ SAN JOAQUIN LOCAL HEALTH DISTRICT 132 Sycamore Street $14 North "C" 130 South American Street 300 West Oak Street tree} Stockton, California Lodi, California Manteca, California Tracy, California s. ES-9-21A 145446 A-(WOOD 12.54