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�.Qll APPLICATION FOR SANITATION PERMIT Permit No. ... .. ... . (Complete in Duplicate) Date Issued ..-�ii ht Applica4ion 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.E JOB.ADDRESS AND L CATION_________________ _ = ------------------------•------- - Phone-- 0.� 7� -'------- Owner's Name---------- ------- Address �pZ 7I Address-------•-------- -- •---•----- --- ---•------ ------------ Contractor's Name.----- Pone j Installation will serve: Residence Apartment House Commercial Trailer Court [I Motel [:] Other-[] ' Number of living units: __�___ N mbar of bedrooms - Number of baths I----- Lot size --- --1--- - 3-- Water Supply: Public system Community system ❑ Private ❑ Depth to Wafter Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay am ❑ Clay ❑ Adobe�i`ardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yeso ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _Material___ 1k ------------ a Septic Tank: Distance from nearest well-) __ _ --Distance from founda_tion/p__'__________ -- citY--A1C- ---------- - S - Liquid de th-_#---r-S_,-------Capa No. of compartments_- Q. t Disposal Field: Distance from nearest wellY.�Distance from foundation__ .......Distance to nearest lot iine._��___._ . Number of lines -------- Length of each line_ _/- ��Width vfgtrench�_�.__�------------------- Number ----- -- �' -. ---------- / f/ % .. Type of filter material- .------Dep h of filter material__ _______________Total len th__,__ _______J�.d Y_... = Seepage Pit: Distance.-to nearest well________________------Distance from foundation____.-_-_:__-__.__.Distance to nearest lot line----------------- Seepage Number of pits---------------------Lining material----- ---------------.Size: Diameter-----------------------Depth- --------------------------- f Cesspool: Distance from nearest well-----------____°_Distance from foundation--------------------Lining material-------------------------------- Size: Diameter------------ ----------- -------Depth--------------------------------------- ---------Liquid CapacitY-.--------------------------9als. Priv Distance from nearest well. Size: from nearest-building-____.__________--_______________-_._. Y• ❑ Distance to nearest lot line----------- ---------- - ----------------------------•------------------ --- -- 4 e ------ Remodelingand/of re irin (describe) ••---- ---- ------------••---- -----� -- ---- �- ' ":: -------------------------------------- ---- ------------------------- ------------- - -_ -- ------ ' ------------- ----------------------------------------------------------------------------------------------------------------------------------------- I hereby certify thaf 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] . . t, j By------------------------ ------------------------------- - -- --- ------------ ----------------------------- {Title} = y (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,can be placed on reverse side). f FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._. --• ----(-- - -------- ---------------------------------------------- -------------- DATE- '. �`--------------- REVIEWEDBY----------------------- --------- --------------------------------- --------------- --------------- DATE----- ! �� ---•------------• ------ BUILDING PERMIT ISSUED --------------- DATE----- -------------- ----------------- ------------------ Alterations and/or recommendatio s:---..._._ - ---- --- ----------------------------------•--------------- ---------------------------------•-------•-------- == -s--•----• -- .--- ----------•-•-------------- ------------- - ------------ i ---------- 1------------- ----------==-•------- ---- -------------- ---------------- fd ,� --- --- Date �---- L-------•----- FINAL INSPECTION BY:----------- ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California Stockton, California Lodi, California Manteca, California y. ES-9--2M 145446 ATWPDO 12-54