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APPLICATION FOR SANITATION PERMIT Permit No. _-01 __ 1 (Complete in Duplicate) Date Issued j�L�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 LOCATION----- -------------------------------- Owner's Owner's NameY r-s•} --......-- -•-------------- ------------------ ----- Phone-' {� Address_. y -_ .Jt_...- ?�? `4w � � -----.--.. Contractor's Name-------0-�.,e,,- .X"'- C°- ------------------------------------- Phone---------------------------------•- f" - Installation will serve: Residence 01Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms _-.�c_ Number of baths .-.--(-- Lot size ---� --IK __-1- .Q__---..._--------------- Water Supply: Public system S1 Community system ❑ Private ❑ Depth to Water Table -------- ft. M Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ( Hardpan ❑ , Previous Application Made: Yes ❑ NoNew Construction: Yes�-o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� Sept Tank: Distance from nearest well-N�SIC-Distance from founclation_1.0-1.0 -----._ Material__-------------------______ --------------- No. of compartments-----�--.---•-- ----Size-- /� ------_.Liquid depth---------------------Capacity---- -�_- -- Disposal Field: Distance from nearest well_-,'?1J, 6-A.g Distance from foundation_-/S0------------Distance to nearest loft line---- _€-----_ Ulf Number of lines-_-.- ,........__i___.___ Length of each line_---_--&.1�_/-.....__Width of trench_---r_.�-_________--- Type of filter material&jCP �,R filter material_ ,2-�' _--.-Total length---J---74-.!_ ------------•------ Seepage Pit: Distance to nearest well------------------__Distance from foundation--------.__-..--.--.Distance to nearest lot line----------------- \ ❑ 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 (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 ws, and rules and regulations of the San Joaquin Local Health District. (Signed) -----------------••-------------------------------------- (Owner and/or Contractor) 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 fSSUED---------------------- --------- DATE---- ---------- Alterations ___- --Alterations and/or recommendations:---------- - (�----------- ---------•------------------•-------------•-------------------- �# ------------------•--•--- --- -- ------ ---- ------- - - �/Q ------------- \11 1 FINALINSPECTION ---------------------------- 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 E5-9-2M 145446 ATWOOO 12.54