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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) / Date Issued __�!-�'.� -•� Applica4ion 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__-_ 54/ 0 6 1019-11,111--------- -------------- ----f '-----. 1rJr� ,t74�� --------•------ --- • - Owner's Name---------- ------- - � �---- ------ ------------------------ Phone----- ----------------•------ Address-------- - --------------------------------------------- Contractor's Name-------- ,R' - C` � �5-�`------ ----------------------- Phone Installation will serve: Residence Ap�rtment House E] Commercial q Trailer Court ❑ Motel ❑ Other El� um Number of living units: ----- er of bedrooms -------- Number of baths ---L_ Lot size ----/,.10x_ y_&o_.. Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table G6` ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe;R Ha,-U, Previous Application Made: Yes ❑ No Ej New Construction: Yes 0 No ❑ ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---A1QA&-Distance from foundation----Pd-`.........Materia------. --. �__ 9 No.. of compartments..._. ----------- --Size_.--5-6--- 36----.----Liquid depth------�- - -----.Capacity Q Disposal Field: Distance from nearest well....AJOALDistance from foundation------1-�� _Distance to nearest lot lin �-E-_. ' ---- of lines---------------f-- --------Length of each line--------.-.amu~.__�.-----Width of trench.--------2'V' ---.- __-______-_ Type ar filter material._--f: -------5X__Depth of filter material--------/, _ Total length__.___-�,a---_-----_ _ Seepage Pit: Distance to nearest well---.ft`Q.11�g.-Distance from foundation_--3Sf----- Distance to nearest lot line----- ld-�___. �T f Number of pits--------Yf-----------Lining material---��-jRt4 ize: Diameter-_--, 3-------------Depth_-----.��'-------------_- Cesspool: Distance from nearest well------------------Distance from foundation. - Lining material-__--.._._ ` ❑ Size: Diameter------------------- -------- -------- Depth-------------------------------- -------------------Liquid Capacity--- • ---------------------gals. Privy: Distance from nearest well------------- -----------------------------------Distance from nearest buildin ❑ Distance to nearest lot line--- --------------------------------- ----------•--- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------- --------------------------------- -----•---------------------------------•------------ ---------•-------------•--- ----------- •--•--- ----------------------------------••-----------------------•----------------•----------• ------------------------•--•-------------------•------------------------------•--------------- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, and rules and regulations of the San Joaquin Local Health District. (Signed) - ---- ------ --C ----- --------- !9,weer and/or Contractor) By-- ---- -- --•--- - -- ---- -•- ------- (Title) -, --------=��-------------- -- - ----------- ------- (Plot plan, s owing size of lot, location of system in rela#ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---------------------------- BY------------- _-------------_ -,-•- -_-- DATE----- REVIEWEDBY---------------------------------- -------- --------- - -- -------- -DATE -- -----•--------••-------•-------------- BUILDING PERMIT ISSUED--------------------------------- ----------•-------------------- ------------------ DATE-------------- 0 Alterations and/or recommendations:- -----.-------- -----_-.... �- ---------------------•--------• ------------------------------------------------ -------------- --------- -------•------- •-- ---------•---•------------------------------ ----------------------------- ----- ---------•------------------------------------- ---------------------------------- ---------•---------------- ----------------•--------------- -------------------- -------------- , FINAL INSPECTION BY:------ Date...: �f-= --------•--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreot 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWDOD 12-54 y