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APPLICATION FOR SANITATION PERMIT Permit No. ._..6.. . (Complete in Duplicate) 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 Count Ordinance No. S49. JOB ADDRESS AND LOCATION_____- ___,_ - Gt -GZJ' -- ---------------------------------------------------------------- Owner's Name----�• •�. ------=---- Phone__.--------•-------------- ----------------------------------- Address J�- --------- ks _C ,:-4- - ------------------•-----------------------• -------------------•-----------•----•--- Contractor's Neme 'V - -•---•---------------------------------------------- ------------------------------------------- Phone Installation will serve: Residence�ff�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other E] Number of living units: __/____ Number of bedrooms __;?!Number of baths J__._ Lot size --------------- 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 ❑�C y❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑' No New Construction: Yes ElNov j 7 f 1 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-_-_l'D---------mat riaL.t c'-� ------ ------------------- -- r No. of compartments.---_��.. Size--�.._- _ Liquid de th------- -----------------Capacity..- - - [�--:-•-- f3 q p Disposal Field: Distance from nearest well, b-------Distance from founclati n___f_Q__.__.____.Distance to nearest lot line�.a�__. Number of lines_______ ______ Len A of each line____ P-6-------•_._.Width of trench__-��--.-__-_ Type of filter materials--i- �;7b-�, Aep (h fJ rl er material-----___S_'----------Total length____)__ -------------------------- ❑ Number of pits----------------------Lining material--_--------------------Size: Diameter----------------------Depth---------- Seepage Pit: Distance to nearest well________________ Distance from foundation__....._______.. Distance to nearest lot line_- Cesspool: Distance from nearest well----------_-------Distance from foundation--------------------Lining material-_..______________._ ❑ Size: Diameter--= --- -------------------Depth----------------------------- ----------------------Liquid Capacity----------------------------gals. Z Privy: Distance from nearest well-------------------------------------_-------------Distance from nearest building.___.____.__._______- ❑ Distance to nearest lot line--------------------- ------------------------------- ---- Remodeling and/or repairing (describe):-------- ------------------------------------- • -------------------------------------------- __.... -----•------•---------•---••---------•-------- _____--•_------------------------------------------------------------_-----------_---------------------------- -----------________...___._____.---__________._______-_____________...._____-____-______._-___________-.___-_ -------------------------------------------------- ___________________ � I __________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that 1-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)-- rG4 � '-- c_ ' �`�- ---------- (Owner and/or Contractor) By:--------------------------------------------- ----------•------------------------------ -------------------------------------------(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 APPLICATION ACCEPTED BY---------�- ------------ - ' .............................----------•-•--------•----- DATE---- � -------•----------------------- REVIEWED 8Y --- -------------------- ---------------------- -----=---------------•-•--•------•---- DATE---•----------`• BUILDING PERMIT ISSUED-------------- - = - DATE i Alterations and/or recommendations. __._._ _ V __.__.:. --••---------------•-••-------------•---------------------•---- ----------------------------- --------- ----- --------------------------------------------- ---------------------------------•--- ---------=-------------------------- • l... , A --------------- -• ------------------------- ------------------------------------------••-------- ------------------------- ----------------:-- - -- . ----------------- --------------------- -------- -- ------------------------------- -----------------------------------------------..------- FINAL INSPECTION BYE --------------•---------------- Date------------------I 1 SAN JOAQUIN LOCAL HEALTH DISTRICT N 134 Soufh American Street 300 Wesf Oak Street 132 Sycamore Street 814 Norfh "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California Ea--9-2M 145446 ATWOqD 12.54