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APPLICATION FOR SANITATION PERMIT Permit No. _g- �_ _-..._... 1 (Complete in Duplicate) 1 Date Issued __fit_}V- - pp ica{ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. its application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION - b ., ---------------------- ------------------- -------------- -------- Phone ------- Owner's Name --- -------- -t ----• '`-' Phoned.. - ---------------- all �J` -----------------•-•------------------------•----------------------.------------------------------------- ----------- Address- Contractor's Name--- -------------------- ---------------------- --------------------- Phon ---- ------------------ - � ---�-'•-`�---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: umber of bedrooms.. Number of baths J----- Lot size rs J4-0--------------------------------- ¢ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table A ft. Character of soil to a depth of 3 feet: Sd Gravel ❑ Sandy Loam ❑ Clay Loam E] Clay E] Adobe Hardpan E]an Previous Application Made: Yes F] No New Construction: Yes KR/No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public'sewer is available within 200 feet.) Septic ank: Distance from nearest well_,.."�-Qr___Dista ce from f undation_ 0 r.p_.Ma teriaP_ Q_,� c k------- Septic No. of compartments_..1Z____ ____________..Sizes '' __-fir G-__.Liquid depth __-_.____Capacity._ _ .i ei Disposal Field: Distance from neafrom faundat�n.-.A�Q-.Distance to nearest lot line----------------- Number of lines-__�---.------. ..-Length of each line_--�O---- - -----=----Width of trench ---------------------------- Type of filter material_ ..- .___' Depth of filter material___ __111_____._____Total length--__�.®------------- Seepa Pit: Distance to nearest well___.4_�.Q-_------Distance from.founi ation-_lf-k.Distance to nearest' lot iine."s------------- {a_ Number of pits....... .............Lining material_---...__ _ _ Size: Diameter._____ �_`1- Depth_.. _#____-____-__-__-_ �) Cesspool: Distance from nearest well-----------------Distance froW foundation------------------. Lining material------------------------------------- �'`� ❑ Size: Diameter Depth. � ! ------Liquid Capacity- --------------------------gals. riv Distance from nearest wail-------------------------------------------------Distance from nearest building---------------------------- -------------- ❑ Distance to nearest lot line-----�--------"--------------- --------- ----- --•----•-----------•-------------------- -------------- ---------------------------------------- Remodeling and/or repairing (describe):------------'---C C---- ------- -•-- ------- � r ----------------I..- ------ ------- ------------ -•----- -------:•-------------------- -------•----------------------•-•---------•---------------- - � ---- - _ 1�+.R...T y��-� U @A -- = ------------------------------------------------------------------- ------------------------------- -------------------------------------------------------------------------------------------•-•------------------------- ----------------------- 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. __._ ----------------- ----- -- --- -- ---.---------------------- --------------------- -- (Owner and--A Contractor By------------------------------------------- -- ---- -- - --------------•---------------------------(Title, - --- - ------ (Plot plan, showing size of lot, location o sy in relation to wells, buildings, etc., can be placed on reverses e). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY_C_'5---------------------- - ------------------------------------------ ------ DAT __ -------------------- -------------------------------- REVIEWED ------------------------------- REVIEWED BY --- ---------------- - --------------------- --------------- ------------------------------- ----- -- DATE. BUILDINGPERMIT ISSUED-------------------------------------------------------------•-------------------------------------- • DATE----- ------•--- ---------------------- Alterations and/or rec endati t ----------- ------------------------------ ---------------------------------------------------- --- --- ------ -- ---- ------------------------------ --------- --- FINAL INSPECTION BY:.. ) Date.... ........."� SAN JOAQUIN LOCAL HEALTH DISTRICT • F 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C' Street Staekton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145445 AT-nOD 12-54