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APPLICATION FOR SANITATION PERMIT Permit No. --�-Z-- E � (Complete in Duplicate) pate' 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 made in compliance with County Ordinance No. 544. �,�v 4..� --------------------------•---•-------- JOB ADDRESS AND LOCATION-----------�.--�-- --------------�--�-• ------------ ----�:--�---=- �----- •- -- Owner's Name-----�_1!_0---k-M,_-�`-` 1-1 --------------`--w / •_ P''l _ f ------ ---------------------------- Phone------------------------------- Address--------- f----_--------------r-----, ----�----r------ •----------------------------------------•-•-•---•- -----------•--------------------------------- Contractor's Name---= n�� 1:'!. '= �� `� - � ---------- ------------------ Phone ° Installation will serve: Residence [3 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....i- Number of bedrooms __ . Number of baths /___ Lot size .___--� ZtZ7______-_________ Water Supply: Public system ® Community system ❑ Private ❑ Depth to Water Table ->53, q. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,[ Hardpan ❑ Previous Application Made: Yes ❑ No [�J, New Construction: Yes ❑ No [� ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) E Septic Tank: Distance from nearest well, d)t, -Distance from foundation--lC`3.______... ' Material__)�-_-c-__/ ->� _____- ❑ No. of compartments------c- - -_Size____f7 Liquid deth-..---- ---------Capacity ------ Disposal Field: Distance from nearest well_Af 1'h-CDistance from foundation____�l_h____.._Distance to nearest lot lines -_----- ❑i Number of lines------ ' ----------Length of each line-------._Q._...__.If----Width of trench------ -- ------------------- Type of filter material__ of filter material........ __g........Total length---------`Z_Q_________________ ___ Seepage Pit: Distance to nearest well..../�V`�`Mt.-+_Distance from foundation----/_?........Distance to nearest lot line---- ------ Ek Number of pits---------I-----------Lining material---��,'.__.�__:•°A�'�'ize: Diameter......__`--------------Deptk- ---------____-- 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-_------_-------------------_--------------- Remodelingand/or repairing (describe):-------- ----------------------------- ---------------------------------------------------------------••----------.....--------.----..--_-•--------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- -------------------------------- ----•------------------------•----------------------- ----------------------•--------------•----- ------------------------------------•--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laths, and rules and regulations of the San Joaquin Local Health District. �J f _/....� ='� ----- ----F --- = .....�-= --------=------------------------------------------------------------(Owner and/or Contractor] (Signed)----------i---- -------- ---_ � - _ By: -.- ...Q_.e� t_._f'� (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 ACCEPTED BY------------------------- DATE------- ----------------------------------------------- REVIEWED BY DATE -----_---------------------- BUILDING PERMIT ISSUED----------------------------- - DATE.------------- --- - �-- - -- -------•--- Alterationsand/or recommendations:------------- - ---- --- ------------------•----------------------------------------•-------------------------- - ----------------------- --------------------------- -- ------------------__________________________------------- ------- _-....__.._________. __ ._ ----- - ------------ _______._________.-..-_-_______..______-_________-__________ ___________________ ------ ----_--_- � - -. ---- - _ _ ___ ______________ ___ ___ __ ______________________ FINAL INSPECTION BY:. Date SAN JOAQUIN LOCAL HEALTH DISTRICT 930 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California rs--9-2M 145446 ATWOOO IZ-54