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APPLICATION FOR SANITATION PERMIT Permit No. `�S (Complete in Duplicate) /�/ Date Issued __�y(_-�ts_-- Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein described. This ap lication is made in compliance with County Ordinance No. 549. r`ffC-f�U � 'O�5 — fSp.-t�'L JOB AD RESS"~AND LOCATION---`----- ¢y.4 .� y �- Owner's Name s `� C!' �"'`�!_.. one------------------------------------- ----------Address------------------------Contractor's Name------------ ` ------ --- - ----- ----- --•-- ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court otef - Number of livingunits: ( 0 Other ❑ ...��Number of bedrooms _�- Number of baths __.l-_ Lot size ___._.-�_ AF y__ ------__ ___ } Water Supply: Public system ❑ Communitysystem `� ----- Y ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob<t l]--Hardpan ❑ Previous Application Made: Yes U�o ET ,New Construction: Yes LI—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: . e (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest r�" (F well tance from fodat•on "No. of compartments_..__ _ -------•- ------ - --- -------Liquid depth------ —+�------------------------------ ---- ----------- ------�� ------Capacity---------- Disposal field: Disfance from nearest well------ ---------Distance from foundation-------------------.Distance to nearest lot line__________________ ❑ Number of lines-----------------------------------Length of each line_---------------------------- Width of trench.----------._-- Type of filter materiai___--___,----------.-_-Depth of filter maferial-_____________________Total length-----------------Seepage Pit: Distance to nearest well-.__�' _ ,iV ' �q -Distance rom foundation_____ 5---__.Distance to nearest loft line ----------- 51' Number of Pits.------ Lining material �_ -_ -size: Diameter_-_. `� � ..d ---- --- Deptn.--- -------------- Cesspool: Distance from nearest well----------------- Distance from foundation._.._.______._____.Lining material-____._..-._._-----_.__ Size: Diameter--- ---- --------- ---- --- -----Depth------ ------- ---=----- --------- ----- ------------.. --- ----.Liquid Capacity---------------------------- gals. Privy: Distance from nearest tivell _.---__-__-_--.____-_--------------------Distance from nearest-buildin g------------------------------------------ ---❑ Distance fo nearest lot line------------------ �. _ ---------------- Remodeling and/or repairing (describe):---__---_------------- I hereby certify that I have prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a i,fc�f�rf the San Joaquin Local Health District. (Si neSeptic Tank Service gd) -•----"--- X206 Sc:lslc'osacln_--FiO 2-70 Owner and/or Contractor) By: Stockton, C.QL : llf. -----------�' .� Tale (Plot plan, showing size of lo+, Iota}ion of system in relation to we11s, buildings, etc., can be placed on reverse side), FOR DEPARTMENT USE ONLY v. APPLICATION ACCEPTED BY-------- ------------------ � �; DATE t"e --- - - -- -- -- -- ------------------------ REVIEWED BY ---------- ------- -- -- DATE ..J BUILDING PERMIT ISSUED---- - -- -- DATE.----. - Alterations and/or recommendations: -_..- ------•-----••---------------"---------•---- ----•- ----- ----------•---•---- J -- ----- -=--------••---- ---------------•------•---•-------------------.------ 1 v .._ -----_- " - ------ -----------------------"---- ------ --------------------•----------- -------•------------------------------------- --------------------- FINAL INSPECTION BY:--- � Date.-.-- ----------------------------- ------------------------------ --------- SAN ate. -------- SAN JOAQUIN LOCAL HEALTH DISTRICT f30 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street Lodi, California Manteca, California Tracy, California {} Es--9-2M 145446 ATWana 12-54 /