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APPLICATION FOR SANITATION PERMIT Permit No. (f (Complete in Duplicate) Date Issued --�-------•---____-- 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-- '1--.---- j--- X---- -a.- --_ Com.--- .1 J�f'ca6 __9 ... _�flt~�c_ e__ __f1T_..1 C C._e_xl .R�' Phone Owner's Name---- -- --- - --------- ----- Address---------5_/ YYJ---------------------• ---- t�' Contractor's Name-----e f'S��Sl� �� ------------------------------------- -- Phone------.--------•--•-•--_- ------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _• Number of bedrooms ___LNumber of baths __I..-- Lot size _.� '_�_ `__ _d_o__`_____________ Water Supply: Public system ❑ Community system ❑ Private Eg---Depth to Water Table __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[-Hardpan ❑ Previous Application Made: Yes ❑ No ©— New Construction: Yes P---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---__-___.__.___Distance from foundation-------------------Material------------._-_---------------:_______--___-. ❑/-,y y No. of compartments---------- --------- -----Size--------------------------------Liquid depth.-------------------------Capacity--------- •----------- Disposal Field: Distance from nearest well--O----_-Distance from foundation____1P"_..---Distance to nearest lotline__ /-. _____ 9`)qW Number of lines_____________�____ Length of each line__,:__3--_-�_�._.��.._.Width of trench_____.__.__SV"-____----._._ Type of filter material._... X S' -Depth of filter material--- '--_-_.Total length----------1I,? _______--__-_____-__ Seepage Pit: Distance to nearest well...., -p_�. Distance from foundation----a:a_"____.Distance to nearest lot line-._----___--___._ Number of pits.........I_- .......Lining material__&-A. _2�c_...Size: Diameter.---.S3...........Depth. ___.42,s~' --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material____-- -.___'.__________._.__--___-. ❑ Size: Diameter-------- ------------- ---------.Depth------------------------- ------Liquid Capacity------ --------------------gals. Privy: Distance from nearest well---------------------------------------- ------Distance from nearest building-.------------------- .------------. ❑ Distance to nearest lot line _6 Remodeling and/or repairing (describe):-.---G'e Lit ��----------------------------------------------------------------------- ---------------------------------------•------------------•------------------------------•----------------•.--•-------------------•-------•-•----------------------------•------•--------------------------------•---------- --------------- -------------------------------------•----------•---•--------•-------------------------------------------------------------------- ---------------•------------- ----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State s, and rules and regulations of the San Joaquin Local Health District. ��' (Signed) l !_,3 / �1 .G �{ ner and/or Contractor) -------- -- ----- ---------------- --------------•---•-- ------(Title)--- ` --------------------------------------- By:(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 _ DATE_.-__....._ - APPLICATION ACCEPTED BY__________________________ ___ __ _ _ Q 1� REVIEWEDBY----- ------------------------------ - ----------------------------------------------------- BUILDING - - - ---- --- -- ---------- i T-(..��---------------------- DATE-------------------------- --------------------------------- BUILDING PERMIT ISSUED----------------------- ------------------------ ------------------------------------------------------ DATE-------- Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-----•------------------------------------ FINALINSPECTION BY. --- ----------•--------------------- -------------------- Date-----------�/6-- 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 ES--g 146445 ATwono