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APPLICATION FOR SANITATION PERMIT Permit No. ..�Y../.-31--.•-- (Complete iri Duplicate) 9/ Date Issued ___1-?- .•-�� I Appliceion 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 �-' "{ Wit` i� ' . Owner's Name----------�----------- �- �r-- -/-- ' ---�:------- - - -- ----------- Phone------------------------------------ fo-------Alm----------------I--------------I------------- Address-------- �• ----- Contractor's Name--------------------------- Phone----•------------- Installation will serve: Residence [. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�___ Number of bedrooms __3--- NumbA�ofthe Y--- Lot size .� ,2 �tiT-----------------------------------Water Supply: Public system ❑ Community system ❑ ':P�'i�vate h to Water Table -'�__ ft. Character of soil to a depth of 3 feet: Sand ❑ - Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes 0"N' El r TYPE OF INSTALLATION AND SPECIFICATIONS: _ No-septic-tank'o-rticwithinT204 feet�� Septic Tank: Distance from nearest well-,Z�_.__--_Distance<from foundation__,/A--------__Maferyaf_.__ '________________________ No. of compartments_....Z- ____ ---.Liquid depth_.___y�}__----_---------Capacity_/---- i Disposal Field: Distance from nearest well_/_&*0.-----Distance from foundation___.. --....Distance"to nearest lot line_407?9�__.. ` Number of lines--------- Length of each line__-1}Q-�.-----��,----.Width of trench- ___.______--__._ Type of filter material._•Sa_ ...__ _Depth of filter materiaL__..I—__.-_...___Total length___.1 ______________________._ - Seepage Pit: Distance to nearest well----------------------Distance from foundation---------.----------Distance to nearest lot line----------------- ❑ Number o ------------- ------- f pitsLining=material-------------- --------Size: Diameter----------------- Depth.----- ----------------------- N Cesspool: Distance from nearest well-----------------Distance from foundation---------------..----Lining material------------------ _._ Size: Diameter---- ----=-----=-=--------- -------Depth-=----------------------------------- ----------------Liquid-Capacity-- ------ ----- ---------gals. �I - Privy: Distance from nearest well-- ----------- -------------- ------. -Distance from nearest•buildin ---- 9--------------------------------- ------- ❑ Distance to nearest lot line--------- - ------ ------- -------------------- ------------------------------------------ Remodeling and/or repairing (describe):-- -------------- --------------- -•----- -----------------------------------------------•-------- 9 ----------------•---•---•---------------------------•----------••--------------------------- . . ------------- -------------------------------------------------------- •--•-----------------•-------------------------•---------------------------------------------------•--------------- ----------•------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County a-n `e's s, ;nd tons of the Saroaquin Local Health District. ordinanc a . (Own'er and/or rContractor) ---(Signed---T -------------- - ----- �� _ - T = --."� - -----------��-- ----- _.. l (Plot Ian, showingsize of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR D11 1,EPARTMENT USE ONLY r .60APPLICATION ACCEPTED BY e ------------------- DATE -�.: = :: ------------------------------- REVIEWEDBY------------------------------------- -------- ------------------------------------------------------------------------- DATE--------------- ------------- BUILDING-PERMIT ISSUED------------- ----• ------ DATE------------------------------------------------------------- ------------------------- Alterations and/or recommendations:------- ----•---- ---- -------------- ......... --•---•---------------•-------•----------------------------------------- ' ----------•---•----------•-•---------•---- -------------------------- ------------------ ---•------•----------------------------- ------•-- ----•-------------- --•--- ---- ----------------------------------------- ---------------------------------------- Date----------_ ------ Date----------_------------ ----377-----------------------------•------_-•- FINAL INSPECTION BY:----- - - SAN JOAQUIN LOCAL HEALTH DISTRICT } 130 Soufh American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street t" Stockton, California Lodi, California Manteca, California Tracy, California ES-9_2M 145446 AT Wa"0 12-54