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APPLICATION FOR SANITATION PERMIT Permit No. ..:17-1-s........ ' (Complete in Duplicate) _ L. 7-S I -Date Issued •--.--------••-.------- g ------ t 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. 544. ��-- "�------: i GtJ?q `-------------•------------------------- ---------------- JOB ADDRESS AND LO-CATION=-'J`--a.._ ----- �` ------�--�-----�-- -- ------ - -------- - ---------- Owner's Name----- S_ ------------- ------------------------- Phone------------------------------------ _ G Address------------- -- ----•-----=••-------------------------------------------- -- -•------------•----•-------....--- --------- Contractor's Name--- ----------------------------------•-----•------- Phone.---- --------------------------- Installation will serve: Residence W,,-Apartment House ElCommercial [ITrailer Court ❑ Motel E] Other [I Number of living units: __ _- Number of bedrooms -----2-Number of baths ---/-- Lot size ------- R ____-. Wafter Supply: .Public system'❑ Community system ❑ .Private 23---8epth to Water Table :_J-p ft. Character of soil to a depth of.3 feet:: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @;--Hardpan Previous Application Made: Yes ❑ INo [tYNew Construction: Yes ❑ No [j" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well_ 4.. Distance from foundation--_e__6_.- l -__._.Materia -------- --------------------- ------ ------ - -`� �-_Liq_u._i_d d_epth.f.-.- .-D--_iGst-anc�e�------Capacity_�_ -r -----.... No. of compartments....... .. - -- - - 'E -Gto nearest lot line_. --------- Disposal - ..__Disposal Field: Distance from nearest well-_.(_ --------Distance from foundation Number of lines---------------1 F, -t Length of each line---------�------------------Width of trench--------- ------------------ Type of filter matenai____ __..Z__-. 'De th of filter matenaL__..f{'._.-_____..Total length------ ____-------------------------- G j r Seepage#: Distance to.nearest well- _ _ --------Distance f Som foundation--_f _____.__ .. Distance to nearest lot line__________.. Q� Number of pits!,!- '.1------------Lining material--- _ _±Yr_K-.Size: Diameter....�-? ---...Depth..__.... ------------------- Cesspool: Distance from nearest well-----------------Distance from foundation___-----__.-.---...Lining material--------------------------- -------- 6 ❑ Size: Diameter-_'------------- ---------------------Depth----------- ----- ---f------------------------Liquid Capacity------------------- --------gals. � Privy: Distance from nearest well--------------------------------- ----------- -Distance from nearest building-------------------.•---------------- ---- ❑ Distance to nearest lot line---- -== -------------------•-•--------------•------- -------------------- ------------------------- ------------ ---- /1�P.c '` i ... ---------------------------•---------------------•--------- "• Remodeling.and/or repairing (describe):-_-__•.__ - ----- ------------- ••-------•-------------------------------------•----'------...------"------____--_-----'-•-----__._ ---'-- -- ---- _t..__.- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. ` i ------------ ------------------------------------ er and/or Contractor) •---------- k --- {Signed]..-- ---- ------- ----- ----- - i: �`� ��----------•--------------------------- I -- - (Title] (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 1 APPLICATION ACCEPTED BY---- -------- ------- ------ •--- --------------- ---------------._ DATE ------ ------------------------------------------------ REVIEWED BY----------------- ------- ---------------- ----- DATE------------ BUILDING PERMIT ISSUED------------------ ----------------------- DATE------------- - ------------------- ------••--------- ,��.......- Alteratians and/or recommendations;------------------________________________ ----- , --- - ------------. --------Z - -------------------- .rwr � -�- f: _ ----- ------------------- .�___.•__.- .. 6 t Z - ____________________________________ _ _ _. __Dafie--------. " - ------------------------• FINAL INSPECTION BY:--(:. " ---•---------------• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3oo West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWOOO 12-54 _