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t'1 APPLICATION FOR SANITATION PERMIT Permit No. --1P-9'?......- / /A (Complete in Duplicate) Date Issued .-_-- ------•- --_-_-- Applica+ion is hereby made to the San Joaquin Local Health Distract 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------ .ltJ ---r ��.__ Phone----50 ., Owner's Name---------------------- - !O G SQ..r.� Address----------••---------------•------------....9----------- ------- ------- ----.....-----••-------- ---•----------------- -------------- .._--- Contractor's Name----------------------------� ---------------------- --------------••--------------•------ -- Phone_ 6 Installation will serve: Residence 2--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ D --- x--_/o ' ----•- Number of living units: _- -- umber of bedrooms -_Number of baths --�--- Lot size ..� ---- Water Supply: Public system umber system ❑ Private ❑ Depth t Water Table .A10ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe 21-'Hardpan ❑ Previous Application Made: Yes ❑ No Sand Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest w i._ _-Distance from fion dation-- - -----------Material_-- '-.------IA"! --- No. of compartments.... ---Size�,3!A -- q cl/th-- �� CapacEtyo ' i osal Field: Distance from Weare t well �..FWA-)_Distance from found ion-f Q_-.-----__.Distance to nearest lot line_----a -_-. -r Disposal sp / r� Number of lines------ ------------ ------------ - hof each line---- �-_._.._.Width of trench-.mow-- _-. • se � � Type of filter material---/�1_._Rk_-De gth'of filter material-........ �.�---Total length----------------------- p �' Distance to nearest lot line -------_ Vf T Seepage �t: Distance to nearest well-1`1-�----.-Distanc��fro��m �foundation---__. - � j I � � Number of pits---J-------------_-Lining material__k1\ ;Gdi-----.Size: Diameter----.�-3.-_--__-Deptn-n��----.--------_-_-_- Cesspool: Distance from nearest well---------------_-Distance from foundation._.- -------------.Lining material------------------------------------- r ❑ Size: Diameter----- ----- --- ------- --------Depth-"---------- =------------ -�------- - -- -----Liquid Capacity----------------------------gals.. Privy: Distance from nearest well---------- ---------------_s._-...------------- Distance.from nearest building------------------------.._- ❑ Distance to nearest lot line--------- --------------- -------------------- ----------------- -------- ------------------------------------------------------------------- Remodeling and/or. repairing (describe) ---------- ----------------------------....---------...--------------------------------•---------------------- --------•---------------------- 'a I here certify that have prepared this appl' tion and t #.he`work will be done in accordance with San Joaquin County ordinances, Stat laws, an rules and gula+ions f + e San Jo quin Local Health District. = -------- _ Contractor (Signed)-----------------•--- ---------- -- -- - -- - - ----- - - {� ) ---------------------- -------------------------------------- - -- ------'-------------- {Tit A (Plot plan, showing size of lot, location of system in relation t ells, buildings, 7, can be placed on reverse side). FOR DEPA TMENT USE ONL APPLICATION ACCEPTED BY------------- - -------- - - - --. DATE---------------- - ------ -'"'r �--�•�-~ •- ------- REVIEWEDBY-------------------------------- - ---------------- DATE------------- ------ J BUILDING PERMIT ISSUED------------------ --------�---------------------------------------------------------------- DATE Alterations and/or recommendations---------------- --------------- - ------------------------•-------------,------------------------------•--.._._..----------------------------- ,' � ...` ---- '`- -------------------------------- --- ... ---------------------------------------------- FINAL INSPECTION BY:. ----------------------- 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 ATw000 12-54