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so APPLICATION FOR SANITATION PERMIT Permit No. ........................ 1r��J (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. U�_ JOB ADDRESS AND LOCATION-• -�------- -------- --- /-----�------' ---- ------ � �} ,� �)�c.f h,- --------------------------------------------- ---------- Owner's t� `� a(}�_ •----•-------------------------------------------------------------------------------------------------------------------------------•-------------------- Contractor's Name_... DA X41__ ,---------------------------------------------------- Phone.. r ' �•�� Installation will serve: Residence [011"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __d----- Number of bedrooms `7 Number of baths ---A--- Lot size __-_3rd------ ----/-0---0------------------------ Water Supply: Public system El Community system ❑ Private �pth to Water Table --�_�?. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ y Previous Application Made: Yes ❑ No 5'� New Construction: Yes [No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; Septic Ta k: Distance from nearest well-----------------Distance from foundation--.-_-----______-Material------------------------------------------------- c No. of compartments------------------ -------Size--------------------------------Liquid depth--------------------------Capacity-••--- ---------------- Disposal Field: Distance from nearest well- ..-..__ ---Distance from foundation--------------------Distance to nearest lot line----------....... Number of lines-----------------------------------Length of each line------------------.-----------Width of trench----------------------------------- o Type of filter material-------------------------Depth of filter material--------------..-.-----Total length--..----.-----.---_--_--_-----_--.�.__-. 6 Seepage Pit: Distance to nearest well....y_ --------Dist from foundation__ p,_Disfan ce to nearest lot lin _ ______________ L'T material i e: Diametr_---.. ----Deptn.------Number of pits.-�------------------Lining _ __ . �.d..._.. -.-------------- Cesspool: Distance from nearest well-----------------Distance`f of f'pnd�fio' ______________Lining m ion---- El Size: Diameter.--- Depth Liquid Capacity------•-•-------------_---gals. Privy: Distance from nearest well-------_---------------------------- ------Distance from nearest building------------- ---------------------------- (� ❑ Distance fo nearest lot line ----------- r ..: ----------- -------------------------------------------------------------------------- �l Remodeling and/or repairing (describe)____________________________ _ - ------_.-- ----- �-------�---��------ - --------------------------------------------------------------- - ------------------------- - ----------------------------------------------•----- ••--------------------------------------------------- -- ------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- 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).,--- -------- ` --------------•-------------------------------------------------------(Owner and/or Contractor) By:---------- --- - --------- (Title)- 1 -------------------------------- - (Plot plan, showings f to+, location f system in tela+ion +o wells, buildings, etc., can be placed on re4Jrse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- DATE REVIEWEDBY DATE----------- ------------------------------------------------ 's BUILDING PERMIT ISSUED - --------------- DATE----- -------------------------------------:--_-,---.-------- F Alterations and/or recommendations:---.---___.__ .__. ----------------------------------------------------------- - ---------•--------------------------------------------------------------- S ----- -------------_------------- ------------------------- -- - ------- ---- --------- ------- - --- ------ -- �/'' FINAL INSPECTION BY c.-------- - ------- Date. L "---- -��- 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 E5-9-2M 145446 ATWAO" 12-54