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APPLICATION FOR SANITATION PERMIT Permit No. ._( 3 (Complete in Duplicate) f Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install te woork herein described. This application.is made in compliance with County Ordinance No. 549. ? 1 W A, JOB ADDRESS AND LOCATION..--- -yy- ,�l{-_ Owner's Name._____ • .E. ''rix -- /� ,. ----•-----•-••-- -----••-• ------ ------ -� ----- - ---------- - - - -- Phone---Z"_ ��-�7--_.-----•---- - --------- - -- - Address------------- Contractor's Name---- . _•-r-- •____• ----- ---------------- ------ - ---------- -- -----------•-------------•-----•------------------•------- Phone----•------------- ------•------•- Installation will serve: Residence-2 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J-----`Number of bedrooms _._ - Number of:baths ---t--- Lot size --------6LA -------------------------------- Water Supply: Public system ❑ Community system ❑ Private, ] Depth to Water Table �--c?___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan izi Previous Application Made: Yes ] No ❑ New Construction: Yes ❑ 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...:- _��:-._ _. No. of compartments.-------.2.- Size ..?}'.._ ' ---J- Liquid depth.------y---------------Ca pacit Disposal Field: Distance from nearest well.-4 a'`-__Distance from foundation___ - .......Distance to nearest lot line... ---__. ! ] Number of lines---------/-_-y-_--_._-_-_ Length of each line_____-�i_d------------------Width of trench '� ---------------- Type or filter material_1.3,40t,�------Depth of filter material____- ------------ length------I.P_____________ Seepage Pit: Distance to nearest well ._, /_Q'------Distance from foundation----/_QD'--.Distance to nearest lot line__4�'-, ___ 19 Number of its___-- size: Diameter-_43--dog P /--------------Lining material -------- �. -- --Depth--------"'w'. "'------- p sorest°well------------•____Distance from foundation--------------------Lining material._________-______-_._ _ -___-- ess ool: Distance from n ❑ Size: Diameter---------------------- ---------------Depth---- ---------------- ------------- -----Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------_---------------Distance from nearest building ❑ Distance to nearest lot line.____-_.______________________ _ ---•---•----- ---------- moi} 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed_._____-.._ ....... �__ Owner and/or Con ti../-------- -------------------------------------------------------------- { / tractor)By:__.... --- ------------ (Title)(Plot plan, showing size of lot, location_of:system in relation to wells,,.buildings,_etc.,._can.be_placed,on_reverse side). �_ a FOR DEPARTMENT USE ONLY a _ APPLICATION ACCEPTED BY.._.. ,- 4 - DATE------------------------------------------------------------- -----------------------------------------------------------------BY f---- ----------- - --------------------------- D✓ �- -----`-`-------- BUILDING PERMIT ISSUED _ - f.+p,�., .1 � ---------•-----------•---------- -------------- AST E + - - - ----------- ---------------- Alterations and/or recom ndations:_-_-_.--fSr�.. _ ..Gv�- % - r`" . ' ______________________________________________________________________________________________ __.. A�� FINAL INSPECTION Date BY• ---. _. i� /O��- �� ------------ _. ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 ATWDUU