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1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued !._31/5�-- 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. , .S. 1' 1 'x'- -- ------------------- 0.JADDRESS AND L, QATION_... !-_- _ .-.- r ;� Owners Name-------___- '------ /. J-�------�-------- .._. Phone.,�1T�- ------------- � Address { --------------- ------------------------------------------------------ Contractor's Name------------------------- ^-------------- -------------------- ------------------------------------------------------------.-. Phone--------•---------•---------------- i Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size __________ _ _____________________________________________ Water Supply: Public system ❑ Community system El Private �epth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel Sandy Loam El Loam ,Clay `Adobe E] Hardpan ❑ Previous Application Made: Yes � E] E]o ❑ New Construction: Yes [j No E] A,~pP q TYPE OF INSTALLATION AND SPECIFICATIONS: M (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic T Distance from nearest well_.:-----------------Distance from foundation__________________Materjal..�-________- _--._L-_.�.- --.----_-- IJo, of compartments_______ ------------- ,%_'_04_i_---Size--- - - --- - Liquid depth------�- -------Capacity----------------------- _ G Disposal Field: Distance from nearest well-_S. -----Distance from foundation_V_7?�% ! Distance to nearest lot line.--.. .,.......___ "'- Number of lines--------- ,J + .- ,_ ___.. __Length of each line.... .-+rWidth of trench_ p__-_-_E�'__ __._ Type of filter material._ t. f Depth of filter material_ --.Total length______ ____-l6_e-)____..__.- Seepage Pit: Distance to nearest well._______------------__Distance from.foundation-------------------Distance to nearest lot line-_-___..___-__._. ❑ Number of pits---------------- ----Lining material-----------------------Size: Diameter---------------.-------Dept h_:..----------------------------. Cesspool: Distance frorn nearest well-----------------Distance from foundation___------.________ Lining material^_-..-._--__.___,._______.____-.-__. F ❑ Size:.Diameter. -----------Depth-------------'------------------------------`- cl iquid Capacity - gals. �_e_ - - - Privy: Distance from nearest well------------------ --------------------------Distance from nearest buiildin9-__-.-_.______-_____________--------•----. ❑ Distance to nearest lot line ------------- ----------------------------------- ----------- ------------------------------------------------------------------ -- C c 74 � ? Remodeling and/or pairing (describe):____ ......4''f'-e_r...-�- --'"�--•------- _�'_7 c ' --------------- ------- Y.------------ -- ----•- ---------------------------------------------------------------------- ------------------------------------ -----------. -- -------•------------------------ I hereby certify that I have prepared this application.and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations,of the San Joaquin Local Health District. f- .-e-/--------------�--.--- -------------------------------------- ------{Owner and/or Contractor)�(Si (Signed) ------40- --•----------- -----._.. By=------- y_. (Plotplan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DE3ARTM,ENT USE ONLY -------- -- DATE---- > ------------------ - APPLICATION ACCEPTED BY.... ....:.... � REVIEWED BY---------------------------- --------- ----V-- 40 DATE BUILDING PERMIT lSS1JED.__. ------- ------ ---- -- -- --------- DATE --- - •--------- -� 0. 4�-------- �' 1 � r 7 __ :.::.:----------..-------__:___:_----------------------------------------------- --------------------------------------------------------------------- ' --------------------- Date-- /E FINAL INSPECTION l SAN JOAQUIN LOCAL HEALTH DISTRICT J130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Erl-111 14 446 eTl..6 12-54