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�k \� APPLICATION FOR SANITATION PERMIT Permit No. __--_ ld..Z (Complete in Duplicate) Date Issued ______f,Z, 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 LOCA�TIyO�N� �� --- ------- ----------------------- Owner's Name---•- 7,.. �� -- •- -----1 ------ ----------------------------------- ------ -------------------------------- -- Phone .- Address.......... -- rr Contractor's Name--------- -----------•----------- Installation will serve: Residence 14—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l-_ Number of bedrooms ?— Number of baths _1___ Lot size .____ fa-A1_0 ------------- Water Supply: Public system system ❑ Private ❑ Depth to Water Table JQ7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ Nov Construction: Yes ❑ No ---�.- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest well------------------Distance from foundation__________________ Material-------------------------------------_-_._.___--. r No. of compartments--------------------------Size------------------------ -------Liquid depth---------------- Capacity.. Disposal Field: Distance from nearest well _Distance from foundation------ to nearest lot line---.0.?Z) � �}-- Number oi lines--------- .._ Length of each line-------L_r.0----r-___ ._.Width oftrench_-� __`_/__________________ Type of filter material---,�-c—___.___----Depth of filter material__....1�__`_r_Total length---.------�"1GI___ ____________ 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--- ----- -------------------------------------•------------------------------ W Remodeling and/or repairing {describe)-------------------------------------------••---------------- ••-•---------------- --- �V -•----------------------------------------------------••------------------------------------------------------------------------------ f I hereby certify that I have prepared this pplication and that the work will be done in accordance with San Joaquin County ordinances, State laws, d and regulati fof the San Joaquin Local Health District. (SigSi ned --o }��-'-- --�------- f-- ------- -- ------- ----------------(Owner and/or Contractor)-, , By:. --- --------- - --------------------- ---- ---- -------------------------------------------------- -- -----(Title)--------------------------------------------------------------- (Plot plan, showing ze of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- --------------------------------------------------- !1 '� --------------------------- DATE----------------� REVIEWEDBY----- -------------------------------------------- --------------- ---- ------ ---- - DATE------------------- BUILDINGPERMIT ISSUED------------------------------- ---------------------------------------------------------------------- DATE Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------I------------------------ ---------------------------- --------------------------------------------------------••------------•-------------------------------------------------- ---------------------------------------------------------- --------------- --------------------------------------•------------------------------------------------------------------------------------------------ ------------------------------------------------ --------------------•----------------------- -•---------------------------•------.------------------------------..-------- t/ " .7 FINAL INSPECTION BY------------- ----------- Date.-------------- --------------- SAN 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 ATW30D 12-54 - � r