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APPLICATION FOR SANITATION PERMIT Permit No. /____�_..... iJ( (Complete in Duplicate) 3 Date Issued --- Applica-ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work_hprein escribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCA I Owner's Name____________ y r' --------------------- - --- ----------- -------------------------- P Address-------------- ---------- -------- ----------------•-- ------------------------ Contractor's ---------------------Contractor's Name------- -- --•- ------ ...... - F Phone- -- -( - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Q Other Number of living units: ---L_ Number of bedroomsG-3__._ Number of baths __L Lot size ___ .....Ji7_0----_-_--------- Water Supply: Public system ❑ Communitst Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand��;Gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No Construction: Yes [!1--1Qoll 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- .0--A____Distance from foundation__/Q -_.-.____.M%1rija _____'___ -.._______- ,_.. No. of compartments____ ________________Size. ` X _________Ls Liquid de th___ '12 ``�� q p Capacity--47''. ------- Disposal Field: Distance from near fvrell_E �_.._ Distance from foundation_�t __..._Distance to nearest lot lin --G--f -•- al � Number of lines___. Length of each line-_-_ __ Width of trench...... ��__p_-r"________---- Type of filter mate ria i�� Depth of filter material.... .. .........Total length------ --------------- Seepage ____________Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- 1-1 Number of pits----------------------Lining material-----------------------Size- Diameter---------.-------------Depth--------------------------------- 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-------------._-----_.________.._______._. ❑ Distance.to nearest lot line-------------------------------- - ----- ---------------------------------- . Remodeling and/or repairing (d scriljes:---- � _ ------------------ -------------------------------•-----• .- ••- --------------- ----------------------------------------------------------------------------------------------- -7-4---- ---- -- •--------- C---------------------------•---------------------------------- ----------- -------------------------------•------------------------- --------------------------------•-----•-- ------------------------------•-----•-------------------------------------------------------------------- I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat law , and rules and regulations of the S Joaquin LocV49 ITh District. (Signed)----- --- ---- - ----- .- - (O�and/orontractor) By:.- �.._ --.. -- - ------ ---------------------------------------------------------{Title)--- ------ ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- ------------------------------------------------•--------- DATE------- REVIEWEDBY----------------------------------------------- ------- --------- ---------------------------------------------- DATE--------- BUILDING PERMIT ISSUED------------- ------------------:_�- ------ DATE-------------- ---------------------- -------------------- Alterations and/or recommendations:---------------- ------- ------------ -------------------------•------------------------------------ . ----------------- ---------------------------------------------------------- ----------- ------ -------------------------------------------------------------------------• ... •--------------------- ... ... .... -------------------------------------------- --- --------------------•------------------------ ---------------------------------------------- --•-------------------------------------------------------------------------- f FINAL INSPECTION BY:-------- - __ Date %_C_ "� . 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-9-2M 145446 ATWOOO 12-54