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APPLICATION FOR SANITATION PERMIT Permit No. ._l..46—el .__... (Complete in Duplicate) G �Q..�-� �� ,�• b Date Issued . ?-.-_rL------ Applical�ion is hereby made to the San Joaquin Local.He<alt�District for a permit to construct and install the work herein described. This application is made in compliance with_Co my rdinan e No. 549, JOB ADDRESS AND OCA N....__. -- .--_ f Zl -.--_- -----------------------------------------------...... Owner's Name f[t, � ---------------------------------------------------------------------- Phone------------- ------------------- Address. ------------._.... Address------------------------------------ - Contractor's Name_.__.____..-_AL., G ------------------------------------------------------------------- Phone_-------------------------•-----•- Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1__ Number of bedrooms _'_._ Number of baths _gn_ Lot size ------ Water Supply: Public system 91-IT–ommunity system ❑ Private ❑ Depth to Water Table fes_ft. ti Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8' lardpan ❑ Previous Application Made: Yes ❑ No P�-- New Construction: Yes g�J'"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL__�Distance from foundation_ C_ _: -_.--_ p � �.�------.Mta'te��a�l-- 4�--�`-- -- -- - w No. of compartments..... ........... .....5ize__� ____-�-��_.__Liquid depth_____7�� Capacity_..._y4__�� i w Disposal Field: Distance from nearest wefi__ Distance from foundation_-_ C__..._.__.Distance to nearest I t Number of lines__________14__ __ Length of each line____ ._.___..____.Width of trench_....` __�_._______-______- - ,� Type or filter material-_--/-�A---_--- epth of filter material_._._I .______..Total length___ _______________f 1 ' i See a e Pit: Distance to nearest w0_.�r_y+��-____Distance from fours ation___'� p 9� ^______.Distance to nearest lot line___ ____________ Number of pits....... -_Lining material_e_e_�1ze: Diameter____,' "___ Depth----------------------___________ Cesspool. Distance from nearest we#L_______.._.__Distance from foundation--------------------Lining material_____________________________________i ❑ Size: Diameter------------------ ------------------Depth----------------------------- -- - -----------------Liquid Capacity--------------------•---_-gals. r Privy: Distance from nearest well---_---------------------------------------------Distance from nearest building__---____---_-__________--------.----- ❑ Distance to nearest lot line---------------------------------- ------ ------•--------------------- Remodeling and/or repairing (describe)------------- ---- - - :---------------•-------------- f .� -------------------------------------• --••------••-----------------------------------------------------------•----------------------•---••----------------•--------------------------------------------------------------- ---------------------------------------- ------------------------------------------------•------------------------------------------••---------------------------------------------------••---------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed) 6 � L�"K 'J-----------------------------------(� Contractor) �C? f''� SY� �. "+ -----------------------------------------------(Title)--------�� e . ---- - -------------------- (Plot plan, showing size of lot, cation of system in relation to wells, buildings, etc., can be placed on revers ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- DATE _. REVIEWED BY------------------------------------------ ------ ------�---------------- -------------------------------- DATE--- -r_ BUILDING PERMIT ISSUED------------------------- ----------------------------------------------------------- DATE.------- -• _ Alterations and/or recommendations______ _____________ ----------------------- ---------------------- - •--- n s l --- --- - - -------------•--••------------------------.........------•........._- 0- -- � -�!-- -----=-- r�.�--...-2_� -. ----- ?!1_ -------------------------------- ---------------------•----•--------------------------- ------------------------ ---- - ��FINAL INSPECTION BY: Date. ��i ----------------------- ----------------------- --••--• 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 rS-9-2M 145446 ATWOOO 12-54