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APPLICATION FOR SANITATION PERMIT (Y Permit No. ___-7-� ___... (Complete in Duplicate) I/` 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 mode in compliance ith Count Ordinance No. 549. f-•f(�-f Ee�+�a� - JOB ADDRESS AND LOCATION ---------- Owner's Name d - - ----`[-"c�-r__. Phone--------- -------------•--------•--- Address. �!1_.! ---- --------- ---------------- - 01 r Contractor's Name.... --- -- •--------------•-.--•- ----•--------------------------------•---------------•---------------- Phone Installation will serve: Residence 6 rartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_____ Number of bedrooms __. Number of baths ---/__ Lot size ---4-0--- �---• .._ _ " Water Supply: Public system [❑ Community system ❑ Private epth to Water Tabled}_ ft. + Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes.❑ No '"New Construction: Yes A-+4n-F1 ' TYPE OF INSTALLATION"AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearesr'well- _: Distance from foundation__._c0.0_!_..Mafe�iaL__ __________________ ___ No. of compartments.--------41�-----------5ize__+ ' ----N__4/A----Liquid depth_ -dam--------.Capacity--- --°� Disposal Field: Distance from nearer well_��______Distance from foundation_____ya--------Distance to nearest lot li� Number of lines______ _- Length of each line__ _ _Da�_�1 _. k.Width of trench_Z__ - ----------- 4— r - --- g ------ - Type or filter material--- ....-.-_______._Depth cf"filter material-----/�_______._Total length___�_ 0..__._________-______._ 1 Seepage Pit: Distance to nearest wefl----------------------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------------------------------------4:1.P ❑ Size: Diameter------------------ ------ - ----------Depth---------------------_------- -----------------------Liquid Capacity----------------- ---------gals. Privy: Distance to nearest elot'l nle________.--------------------------------------distance from- nearest build----------------- ----------------------------- Remodeling ----------------- -------- 1 Y' g------------ -----------•---------------- t Remodeling and/or repairing (describe):------------------------------------- ----------------------------------•-•-----------------••---- ----- _ ----------------------------------------------•------------'-----------..------------ •---•----•------------------------•-•------------------------------------ ------------------------------------------- ----------------- I ---------------------•--•- •------•-----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 of the San Joaquin Local Health District. r �°�- -- (Signed)--- - •^(�rrto.virtVm 'Contractor) BY•---------49".7 0`' (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-rACC1 PTSD BY---------------- X -.- ---- DATE-----`-- ---- �� REVIEWED BY --- - DATE------4-------� BUILDING PERMIT ISSUED.-----------.... (.. ----------------------------------- --------- DATE----- ---------- ------c2 Alterations and/or recommendations----- ---- ------ ---------------------------------------------------------- --•----------------------- -•-.V --------•-•-------- �,,i--� ----------------------- -------------------------------------------------------------------•---- - --- --------- -------------------------------------- -------------------------------------------,- --------------------------------- � "_c FINAL INSPECTION BY:_.__ 5----------------- -- �� ---- -------- Date------t ------ -- 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 145446 A7W00D 12-54