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CA i e i APPLICATION FOR SANITATION PERMIT Permit No. ..__�,_ � -- •-- (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. 544. JOB ADDRESS AND LOCATION ------------- G' ----------------------------------------------•---------------- L + - ---------- ---- Phone ------------------------------------ ---------------- Owner's Name------------ Address........................ -Address••-------------•-------•------ / --- " ----- LX12 .__ �/' --- 1`"" Contractor's Name--------------------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ `el Other ❑ Number of living units: _- -. Number of bedrooms -.. -. Number of baths -/... Lot size ------------------------1� --- ---- . e - -------- Water Supply: Public system K_-Community system ❑ Private ❑ Depth to Water Table 4 t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes E!1�N_o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Di stance from nearest well--�f-„.Y---Distanc �from foundgtion C4_'*----------Materiai__ll.f �Q:'��- --.---___.-_- . f p•rt[, No. of compartments------��---------.,-Size-- --- - --`J•_--Liquid depth---�------------------Capacity---------J------ � ii Disposal Field: Distance from nearest well-,-. --------Distance from foundation--,- -------------.Distance to nearest lot lin -_'3----....... Number of lines---.---.---i—. Length of each line-----,2. /_--_---__Width of trench_--- dP Vx------------------- Type of filter material-_.51_ ., _-__Depth of filter material....-,1 .--.,---.Total length--------- ----------------------_ I'll , Seepage Pit: Distance to nearest well-.- ----------Distance f om ifou dation--/0_'7!!! Distance to nearest lot line %� a ® Number of pits------f_.-_______-_Lining material_ !-Size: Diameter--- .............Depth---.' d_---_-----------.--- 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 (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 f the San Joaquin Local Health District. (Signed} .A rr -------------------- ----------------------------------------------------------- -----(Owner and/or Contractor) B f ----- Title ----------------------------- ------------ ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). O RTMENT U;R ONLY APPLICATION ACCEPTED BY--- ” - DATE -------P_ �>_4�_ 1,5-9 REVIEWEDBY-----------------------.-- ------ --- ------- -------------------------------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE Alt ions and/or reco mends ' :..L:- - -------- ---� - . - _ _ = --------- __ -------------- ----------------- �. -- ------ --------- - -- F -- --:. f FINAL INSPECTION BY:------C!d'�/ - -- Date 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 149446 4TWOnC 12-54