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APPLICATION FOR SANITATION PERMIT Per NtNo. (Complete in Duplicate) / a Date Issued I 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. u . � --•---- ------------- � - JOB ADDRESS AND ION ` �'l Owner's Name----------- -------- ----- l __ � ....._ J7 ---- Phone ------ Address------------------- -------------------- ---- ------------- - ----------------- -- Contractor's Name- 1` b/-- f�{e ------ j -�-�- oma' ----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: J--_ Number of bedrooms _-/_. Number of baths I... Lot size __-_-"��_- X __�/d---..-___---_._ Wafer Supply: Public system Or Community system ❑ Private ❑ Depth to Water Table Aleft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑. Clay Loam Clay ❑ Adobe Ea—Tfardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: o septic tank or cesspool permitted if public sewer is available within 200 feet.) is fan Distance from nearest well ------- -"Distance from foundation___"._-"__-_-_____--Material_-_"_"-"_--_."_"__-_"_-_____________.._____-___-. No. of compartments Size---------------•-------.--------Liquid d th--------- ---------------Capacity--•-----------------•-- isposal field: Distance from near st well__kDistance from fours on__ _.Distance to nearest lot line__! Number or lines______ Length of each line- '. .Width of trench.-------"t------------ Type __"-.-___- T e of filter materia!____._. -____ De th of filter material-_-.__-"Q. -.""""".Total length""-"_ YP -- - - p Seepage PP : Distance to neares walla, _Disfan fro foundation______ _....___. fist nce to nearest lot line__c�0____-- Number of pits. --- Lining materi _____ - ------Size: Diameter___;---_____.Depth---.Z4�/ Cesspool: Distance from nearest well-----------------Distance from foundation__ _______________ Lining material-".._"...-_-._._________"-_.__-______- Size: Diamefer---------------------- ----De th--------------------------------------------.-------Liquid Capacity gals. Privy: Distance from nearest well----------------------------------------------_Distance from ne&esf building..___..__________ 0 Distance to nearest lot line-------------------:------------------------------- -•-------------------------------------------------------------------------------------- Remodeling and/or repairing (describe) ----------------- -------------------------------•----------------------------- ........ ------------------ ------------------------- ----------------------------------------------------------------------I-----------------------------------------------------------------------I------------------------------------ --- ---------------------•--------------------------------------------•------•"-------------...----•--•-----------------------------------"-----•--------•--------------------•------------------------------------.._....._ - -------------------- --•- --------------------------------------------•---• ----------•------------•--------------------------- ------- --- ------- --------- - I hereby certify that I have prepared this application and +hat 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. Si ned DAY& NIGHT Contractor) g )--•'•'- ""�"3eptie-Tank"3ervice By� �_2Q6_SQ._EldDzada---W-?1-X046----------- (Plot plan, sho g size of lot, 1§ 8fWPrbfCee?Km in relation to w s, buildings, et , can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---- ---------------- -- ----- -------- ---------------------------------------------- DATE-"-----�-------------------------------------------- REVIEWEDBY------------------ ' -1 ........ ---- ----- ----------------------- ------------------------ DATE----------- - BUILDINGPERMIT ISSUED----------------------- -- ----- --------------------------------------------------------- DATE---- - ----------•- Alterations and/or recommendations:------. --- � ..... ...5�r - ------- --- - ------ --------- - ---- _ ------------------------------------------------------------ ----------------------- FINAL INSPECTION BY, . ------------------------------------ ------------------------------------ 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 ATWDOD 12-54