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Permit No. Q__ APPLICATION FOR SANITATION PERMIT ... ..:... ... ... ti5r (Complete in Duplicate) fy s'b 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--------� ---------- - -- -----------------------------------------------------------------I ff Owner's Name-------------- - - - -- ------•-•--��1�J -------------- Phone--------------------�` - Address------------------------- ------- --- ...-. --------- -- - ---------------------------------------------------------------------------------------------------------I� ------------- Contractor's Name-----------------� •. •. ------------------------------------------------------- ------------ Phone.--•-----------------I� Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms -A-- Number of baths ./_-_ Lot size ---1a.4�---X__lvd-____--_---------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table ---------ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E��aidpan ❑ Previous Application Made: Yes ❑ No F�--New Construction: Yes ❑ No 8' 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--X$?Z _IDistance from foundation---1_t�------.Material----- I No, of compartments.......g------------ ---Size--- a__Liquid depth------I_ Capacity..... ------ Disposal Field: Distance from nearest well__�*,I&/Otante from foundation-_-_ Q___.....-Distance to nearest lot line._ ____ Number of lines-------------/..._,...,,.,.____y Length of each line--------0.- `_„_-..-.Width of trench_--- ��_.I� _ Type of filter material__ _ De{�th of filter material----- ..__.____Total length------e `no ------lM Seepage Pit: Distance to nearest well_. ?' ___Distance from fou ation-_----- ---.Distance to nearest lot iine-,lf,;: _--_-_. [GY Number of pits-------f-----------Lining material-L` - ize: Dia meter...... ,�_��______Depth- ---_ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------------------I``_ ---------_-_-. ❑ Size. Diameter------- --------- ------- -------De th-------------------------------------------------- -Liquid Capacity- ----------------------gals. Privy: Distance from nearest well-------------------------------------------_--Distance from nearest building--__._____.__..______-._._I!_________._. , ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------77 -_-_ _ I� - -------- ---------------------------------------------------------------------------------------------------------------------------- --------------------------------- -------------------------------------- IM --------------------------------------------------------------------------------------•---------------------------------------------•-•-•--•----•---------------------------•---------------•---------•------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State flaws, and rules and regulations of the San Joaquin Local Health District. (Signed) �C� Contractor) -------------------------- ----------- KA By:------------------------------•-------•--- �~ Title --•---•---•-- (Title) - - (Plot plan, showing size of lot, locat' of system in relation to wells, buildings, etc., can be placed on rever side). FOR DEPARTMENT USE ONLY I� APPLICATION ACCEPTED BY---- -------- --------------- --- ------------------------------------------ DATE---------- - --- �N REVIEWED BY - . -- ----------- ---- DATE M...._..--• I BUILDING PERMIT ISSUED--- ---------------- ------------- --------- ------ DATE------------- -------- � I!-...._.... Alterations and/or recommendations----------- ---- ------ U ------ -------------------- ------- --- .�' I� _®'----- .- �-- -- ---------------------------------------------------- -- ------ - -- r-------------- ---- ------- FINAL INSPECTION BY:------ --- ------------------- Date-._._------` -.--- � 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 E" 9-2M 145446 ATW09O 12-54