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APPLICATION FOR SANITATION / PERMIT Perm i} No. ___tv�•��_-- (Complete in Duplicate) Date Issued .__ / q 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 CountyOrdinance No. 549- JOB ADDRESS A D LOCATI N._,370_ J j - ' ---------------- --•-------•----------- Owner s Name___ -•---•--------------- 11 Z 4• i-` Contractor's Name ----- ------- -•--- Phon --------- Installation will serve: Residence ❑ Apartment House [] Commercial [] Trailer Court o#el ❑ Other ❑ Number of living units: 7 V- Number of bedrooms _______ Number of baths --- Lot size ___ ,..� Water Supply: Public system Community system ❑ - -' - ----�•---•---------- Private �}--Bepth to Water Table _-Sa ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan [] Previous Application Made: Yes ❑ No VI—Hew Construction: Yes a- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weiiDistance from _ foundation of com artmenis_ -. - �_P- _ ------- ize_.__ _ -- --------Liquid depth------ _ _------- --------Capacity (>Q'd -- -- -- ------- Disposal Field: Distance from nearest well_-_71j__-_--Distance from foundation______f_Q-'-...Distance to nearest lot line_____fy�=-•-__ I �--� Number of lines_____________ l-- - Length of each line----- !.2_Q____--...Width of trench-._._L.�L_'_'_�--------------- Yp � - Type of filter material___._ __L-------------Depth of filter material �' - - -�--_-_-----Tota! length----__2„O--Q _ -- --------•- Seepage! Pit: Distance to nearest well- -Distance om fo ndation___�_��_••__.Distance to nearest lot line___ ) Number of pits--_ ---- ............Lining material_, lvi� I 3 __-Size: Diameter.__-_ _,�-�_----De to-_-. Cesspool: Distance from nearest well------- -_--Distance from foundation._-_------- -.Lining material_--_____--_____- ❑ Size. Diameter--- ---------------- ------Depth- - ------------ 1 ----------------- ------Liquid Capacity- --------------------------gafs. Privy: Distance from nearest well------------------_-----_- ----------Distance from nearest buildin ❑ Distance to nearest lot line g--------------------------------------- --------------------------•-- - Remodeling and/or repairing (describe)_---------_------------------------------------------------------------------- ----------------------------------------------------------------------------- --- ---- ------ ----- -- -- ---- -- ------------ - --- ----- •----- - --- ------ ---- ---- - I hereby certify that I have prepared this application and #hat the work will be done in accordance with San Joaquin County ordinances, St a laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------- E-11-1 air BY:------- ---------- ---- •---•- ---•- (Title)-- (Plot ---- ---------•---- ---------------------------•• or (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR Dl_PARTMENT USE ONLY APPLICATION ACCEPTED BY----_-------- ------- -----------. DATE REVIEWED BY -------------------------------------------- ----------------- - ------------ --- - ----------- ------ DATE-__ �--�-• -- - - -- ------------------------ --------------------------------------- BUILDING PERMIT ISSUED------------- ---------- '- --- ---------------------------------------------------------------------------- -------------- DATE. ---------------------------------- --------------------A tern+ions and/or recommendations__________________-_ - -- -- ------------------- D ------------------------------------------------------------ FINAL INSPECTION BY---------------- <� - ate SAN JOAQUIN LOCAL HEALTH DISTRICT f30 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California 814 North "C" Street f Lodi, California Manteca, California Tracy, California ES---9-2M 145446 ATW000 12-54