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APPLICATION FOR SANITATION PERMIT Permit No. . f o _.7____.... �t (Complete in Duplicate) Date Issued ---1_---`C_-- Applica4-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. JOB ADDRESS AND LLO/C�ATION---�� `��2-�7?�''� ' `"-------------•--------------------••-•-----------------------•--------- Owner's Name--•----- If, --- � Phone. Address________________e 4. -------------- - ��,.�r �-- Contractor's Name "- --------- Phone. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ *)--,/- ---------- Number of living units: __ ___ Number of bedrooms _4--. Number of baths :_ -- Lot size ----_.. __.. - Water Supply: Public system Community system EDPrivate ElDepth to Water Table -------- ft. .Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[!W rdpan ❑ Previous Application Made: Yes ❑ No P'New Construction: Yes ❑ No•?D—" TYPE OF INSTALLATION AND SPEC IFICATIONS: (No septic tank or cesspool permitted if public sewer is-available within 200 feet.) S.Sp�ic,lank: Distance from nearest well__;_________----Distance from- found ation_______________.__.Material--.----_____._._______________________--_--_-_-_. No. of compartments--------------------- ----Size--------------------------- ---Liquid depth-------------------------Capacity----------- --------- 6-2 77 I Disposal. Field: Distance from nearest well---- Distance from foundation___:-_____________Distance to nearest lot line.-_ _ r d''�-------Width of trench------,r+ �r Number d,lines___:-u/----- --------------y-Length of each line_______ - 61 41, Type of filter' material- .Xvl''�Depth of filter'material....I _._.._-___Total length----- Seepage Pit: Distance to nearest well__`+' Distance from ------- 'foundation_______.___•___- Distance to nearest lot lines`'.___._.-. Number of pits _ _ _.' _Lining material-_ _ "_ r ± Size: Diameter_-.-•- ----------------Depth------- Cesspool: Distance from nearest well --------__._-�__Distance from foundation----------_----------Lining material-------------------.- .---__-______. ❑ Size: Diameter------- " t =_==---- Depth----------`---- ------------ -----------------Liquid Capacity_.. ------------------------gals. ------------------Distance from nearest building Privy: Distance from nearest well- ;= --------- 9 - ❑ Distance to nearest lot line- ----------------------- --------------- --•------------------------ -------------- ----------------- --------------------------------- C t Remodeling and/or repairing (describe):----`=-------------!ell ------ - a xti ----"--------------------------------- ---------- a. r-=- - --- -------- --- -----._..._ - ---'`°�-�----- �,.+��. a,. ------ ''^'' - t i --------------------------------------------------------- °qty I herebycertify that I have prepared this application and that the work will be done in accordance rvithSaJoa uiun ordinances, State laws, and rules anAd regulations of the San Joaquin Local Health District. (Signed)_ - �` �t ' .-C� ------- { Contractor] gy:..... ---- - --- � ( � ] (Plot plan, showing size of lot, lacatiop�f system in relation to wells, buildings, etc., can be placed on rever side]. =v .�- .� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED D BY = �----------------•--------------------------------- DATE ��--t 1�/ REVIEWED BY -- --------------------------------- DATE----------- �-1------------------------------------------ BUILDING PERMIT ISSUED------- _ _ i------------ ----- --------------- DATE.- Alterations and/or recommendations:_------------- ---------------------------- -------------------------------- -------------------•---------•------ --------------------------------•---------.------------ F ------------------- -------- - G._ FINAL INSPECTION B / --------•- ------- - --- ------- Date.--- d2---- --------------------------------•---- Y:_�_ . -�-.- --'_-� --- - - �SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California } ES-9 145446 ATWOOP