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10) 11 APPLICATION FOR SANITATION PERMIT Permit No. •.............. ....... (Complete in Duplicate) Date Issued ..-.0_......-��. o-rZ-n 2a-.57 L/ 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. 54 66 5-0 Al 9 JOB ADDRESS AN d -- , 4 i Owner's Name.-•--- -- ------•-• -- ---- - ------ -- -••- ----------•------ ------ ------ - --- ------------ --------------------------- Phone------------- ----- Address -Z -' •-- -------------4 f0 k .. Contractor's Name------ _ --- ----- ----- -------------------- �- --------------•-----• ----•------- Phone-------•----•--------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial N—.Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -.4 -Lof size ...... _.. . __. .. ----------------- Water Supply: Public system ❑ "Community system ❑ PrivateE�_Depth to Water Table .rZ0 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 ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) y/ Septic Tank: Distance from nearest well__:.�, __Distance from foundation----1fo----------Material--_--. ja No, of compartments------- __Size.----- Liquid dept h----'-4FQ-' --------Capacity----4le`d------- � Disposal Field: Distance from nearest well...�.�__Distance from foundation.-AW.1 ..,.Distance to nearest lot line.._.%r .j.I Number of lines__-._-.:. t-.#---.._...._Length of each line___, x -_.Width of trench..------ Type of filter material_1�, _____�'.;A Depth of filter material--../-&..._ ------_Total length---------- ------------------- Seepage Pit: Distance to nearest well.__-------------------Distance from foundation___________________Distance to nearest lot line----------------- F-1 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.......-...__.----..----------.--___. ❑ 4 Distance to nearest lot line.........------------------------ i2emo g and/or repairing descri a '" � "�- -._.. -.. '`r`^-"'--- .--_ �, . , ----------------- -- - .-' - - ----• ---------------------------------------•---------------------------------------------------------•-----------.---------- -------------•-----------------.--------------------- I hereby certify Oat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. (Signed)--- - ---- -- -------- ------- ------ -------------------------------------------- ---------------------(Owner and/or Contractor) By:-- _ --- --- ------- �'`�c -.mss --------------(Title----- {Plot plan, s owing size of lot, Iota+ion 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 ' Alterations and/or recommendations:-,,-------------- ------------------------------------- -------------------------------- ------------------_------------------- - - -----------•--------------------•---'•- -•-- ---- -- •------ --------•--- --- - •-• --------•------------- g / ... ...... . k_., yy ♦ /J .............................................................................................................................................................................................................................. rr .� i FINAL INSPECTION BY:-'-'-'------ ------ ------------------------------------ Date-'----'`. ' 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 E5-9 145445 nTwooa K