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APPLICATION FOR SANITATION PERMIT Permit No. ..{m------------------ ,cf (Complete in Duplicate)Il Date Issued ..-!1`I/S-s 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- , � JOB ADDRESS AND iOCATION-=--� 4-- --------------------------------------------------------------- op 0 Owner's Name-- - - ------------------ -= ------------------------- Phone Address----- ------ ---------------------------------------- -------------------- Contractor's Name_ -- ---- -------- r t Phon�- " .� . If Installation will serve: Residence 10 .A�fm' ent House El Commercial El Trailer Court El Mo [I Other ❑ Number of living units: Number of bedrooms ..L Number of baths ---p Lot size -_._- _-- --------------------- Water Supply: Public system 4__�___ommunity system ❑ Private ❑ Depth to Water Tabled ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam © Clay Loam [I Clay El Adobe r pan ❑ Previous Application Made: Yes ❑ No 4_._1qew Construction: Yes - 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---_-/40-r----.Material_---.----..-- --___---- -- .--_d--- 1- -Capacity No. of compartments-------,�,m,___--------Size_, -'4---K-Y!'O--Liquid depth.-_--'�,--- --- Disposal Field: Distance from nearest well------------ -.--Distance from founciation_-_ - --_/-----.Distance to nearest loft line---- ---------- Number _ ----- Number of lines----------I-----.- -- Length of each line----_----/01-- --------.Width of french--'�9 r��r-------------------- - Type of filter material-_- .- Depth of filter material-.---- - ._ _-.- Total length-----•---- ®---_------------------ II Seepage Pit: Distance to nearest well__-----------------.-Distance rom foundation_--j.©--------Dis ante to nearest lot line---�- -. --- 11 c ''-4.---- ------De to (P--------------------- Number of pits.._.----�----___--Lining material-� �i�_--„ ize: Diameter- p � ��-- - II ; ,Cesspool: _FDistance from.nearest well _from. foundation.,-.___-.-.-___,__ Lining mafieriaL-.--------_-. -_:---- t ----------------gals. ❑ Size: Diameter-- ----- ----- -------------- Depth---------- - ---------- Liquid Capacity ------ ------ --- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ----------------___-_--_-__------------- ,i �J ❑ 3 Distance to nearest lot line ---1----------------------- - ------------------------------------------- ------ S Remodeling and/or repairing (describe).,---------------- ------:------•-••-----------------------------------------------------------------•-- ------- -------• 'F . - •• ------------- --------- --•-_-•--••------------------------------------------------------------- - - ---------------------------------------------•-----••------------------------------------------------------------------- •------' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S, laws and rul s and regulations of the San Joaquin Local, Health District. IfContractor) [Signed} --------------------- �ad�or --- B - --- - -------- � ----- --- - - (Plot plan, showing size of lot, location of system in relation to -------- Wells, buildings,egs, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------- ----- - -------------------------------- DATE-------- I------------- REVIEWEDBY - - ----------------- DATE-------------------------------------•-----------•---------- -------1.-- DATE BUILDING PERMIT ISSUED--=------------------------------ . Alterations and/or recommendations:------------------- ----i=------------------•----------•-----------------------------•------------------------------- ------------------ ---------------------------------- -----•--------- -------------•--•------------------•----------------•------------------ ---------------------------------------------------------------- li ------------------------ ------------------- -------------•------ --- -------------------- -------------------- -------------- ---------------------------------------------------- Date -------------- -------------------------- Date.------- -------------------- FINAL INSPECTION BY SAN JOAQUIN LOCAL HEALTH DISTRICT ii 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C” Street Stockton, California Lodi, California Manteca, California Tracy, California J E5-7-2M 145446 ATWOOO 12-54 J