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APPLICATION FOR SANITATION PERMIT Permit No. •.-7 __ _. {Complete.in Duplicate) . Date Issued ... 12'7 Applicaa-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 LOCATION- ------- 5�. ]-I�----------;7 D-j f1..4 A, , Owner's Name..-- --------•------ #L------- - ---------------------- ----- Phone ----------------------------------------- r< Address------------------------------------------- Contractors Name.------- - L-,:- . ! ,�'_I - -------------.- Phone--- -�1r - -- -�`-°L - ---------- �-^ j_��a Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-/__ Number of bedrooms 3_ Number of baths --/--- Lot size _--_-�,r_ --/--2,l_ Water Supply: Public system 5a,-Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes No i PP ❑ L_T New Construction: Yes ❑ No ❑�,..,,f, � - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Tank Distance from nearest well------------ ..--Distance from foundation------------------ Material--___.----.-------__-----_-_-----..---_.-__ No. of compartments--------------------------Size--------------------------------Liquid depth--------------------- ---Capacity--------------------------------------------- - Didvf8sal - Distance from nearest well_________________Distance from foundation_--__------.._..-..Distance to nearest lot line_-----_-_---..__. Number of lines-----------------------------------Length of each line----------------------------.-.Width of trench--------------------- -- Type of filter material-_---.--,--- -_---------Depth of filter material-------------- ----Total length------------------------------------------ Seepage Distance to nearest well.__i. d %...Distanc�om oundation�6----- -_.Distance to nearest lot line---AQ-.�_. Number of pits---- ---------------Lining material -____-----��- ------Size: Diameter--- -sl------DepM__,9Q_�_ ------------ Cesspool: Distance from nearest well-----------------Distance from foundation ..._.__-.--.Lining material------------------------- + ❑ Size: Diameter--------------------------------------Depth---------------------------------- - --------------Liquid Capacity...------•- ------- -----gals. Privy: Distance from nearest well________________---..-.-- .---_.---.__--.----Distance from nearest building----- -- ---------- El 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. (Signed) ' DAY$ NIGHT 9 )..... ---Septic-Tank-Sere'ew--------J� e --- -- ------------------------------- - ...... Contractor) 1206 So. Eldorado �kO 2-7041: , BY. ------------•--- •------------------------ ----------------------- Title pp !,p { ) ---pinfff/.ddv ----------•------ (Plot plan, showing size of lot, locAW9f*Ybn in relas, building etc., can be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BYQ----------- _- - ----------------------- -_----__ _ ---------------I--- DATE` --- DATE---L3----------•--------------------------- REVIEWED BY--- BUILDING PERMIT ISSUED •-------------------------- ----------------- DATE------`` - -------------------------- Aterations and/or recommendations:----------------------------------- A---- ------------------------ -- -------------------------------- -- ----------------------------------•------------ �-- ------ ----- FINAL INSPECTION BY------------------------------------------------ - ------- ----- Date.- ------------------ - --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americbn Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton,-California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATWtloo 72-54