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�1 APPLICATION FOR SANITATION PERMIT Permit No. ... y.. .r,:. +' (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 County Ordinance No. 549. 1 �tf 5--12 sir~} JOBADDRESS AND LOCAT N------ - -------- = -1�-�- --- - --------•----------------------- ----.....---------------------------------•--- Owner's Name----...)� � :.:.. Phone Address11 - - � :.. -------------------------------------•-------------------------------••-- Contractor's Name.. ------------------------------- Phone---------------- will serve: Residence 2-119partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number°of baths --- - �r�-- Lot size ____ __X___1�.d-`-------------------- f Number of living units: __l___ Number of bedrooms _� Water Supply: Public system [' Community system ❑ Private ❑ Depth to Water Table ft. A4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No Ei'New Construction: Yes 8--No TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �. Septic Tank: Distance from nearest well.._W01A-Distanc_e from -foundation-----L!4?._.__-_-MateriaI___ee_.__ _ _ __-... No. of*compartments......R----------------- Size--+�-f: - F Q ---Liquid depth.-----f ,�,� --------Capacity...-F Disposal Field: Distance from nearest well' -Distance from foundation-_/*........._Distance to nearest lot line--- - ------ Number of lines____ __--�...........n....---.�Length of each line------- --_--��_____._.Widtfi of trench_---.v?�i�Pz_-__e___----._.�- Type of filter material____' - +Depth of filter material---.19._ --------Total length---____-- 7_445 . - :�. Seepage Pit: Distance to nearest well.__hi►- --Distance-from foun tion____________________Di t ce9 to nearest lot line_�------------ Number of pits....... .............Lining mate6al_ee,_A>nAiize: Dia meter__. ______.Depfk_. __.d9_,;�7---_________.___ l � ' Cesspool: Distance from nearest well--__----_-___._-Distance from'foundation.__,-.___.---- Lining material--------------------- _______________ ❑ Size: Diameter---------------------------- 7------Depth--------------------------- ------ ----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------.-.--------------. ❑ Distance to nearest lot line-----------------------------•--------------------------------------- ---•---------------------------------=-------------------------------- 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. l � " I J._., ------------- [ r Contractor] (Signed).'.-.-.- By=------------ -•--..---------------- .... . F-- . ---- -:--------------- ITitle) V- ,e, ----------- (Plot plan, showing size of lo+ cation of system in relation to wells, buildings, etc., can be placed verse siol. - bs€ FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- -------------------- -- ---- --------------------- --------------------------------------- DATE --,-- REVIEWEDBY------------------ ----- ----------. --------. - -------------------- DATE--- p---------•------------------------------------------ 4 'A BUILDINGPERMIT ISSUED----------------------------------------- == ------------------------------------------------------ DATE-------- A----------------------------------------...- Alterationsand/or recommendations--- ----------- -------------- -------------------------------------------------------------------------------�----------•-------------------- -------- y~ ---------- -----�.� - ------ ------ ------•----------------------- ----- "' s £ ' -_ ----- - --------------------- ----------------- --------------------- ------------------------ FINAL INSPECTION BY::-- Date--- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATW000 12-54 '