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6 3-�-�--- APPLICATION FOR SANITATION PERMIT Permit Na. __6 (Complete in Duplicate) Date Issued . Appliceion is hereby made to the San Joaquin Local Health Dis+rict for a permit to construct and install the work herein described. This application is made incompliance with County Ordinance No. 549. ��'}} ------ ----------------------------------------------------------- JOB ADDRESS AND LOCATI N___s�,_�---I-- ---_-�--- - -- ------------------- - - Owner's Name_ e. '°`-------------------- ---------------- ---- --------------------------------------- Phone----------------------------------- ------------ - Contractor's Name-------- Installation will serve: Residence Ut—Apartment House ❑ Commercial ❑ TrailerCourt ❑ Motel ❑ Other ❑ Number of living units: -J___ Number of bedrooms __2,- Number of baths J____ Lot size ____ _________________ Water Supply: Public system 4--emmunity system ❑ Private ❑ Depth to Water Table Vio ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No A�w Construction: Yes L4--4'o_Q_ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t a Septic Tank: Distance from nearest well_A Distance/from foundation______f_ ._.____.Matlerial-_�, ---__ ________________ No. of compartments------�------------Size_ __A__4(__-0-----Liquid depth--q_Z--------------Capacity---S.-_J ------ Disposal Field: Distance from nearest well '- Distance from foundation____1P-----.-.Distance to nearest lot line____ [ Number of lines---------/_____.__ g --_----- -Length of each line__ar�_8 -- Width of,trench "` t �y r. i Type of filter material r_._l1.�_-- ..._Dept,offilterm aterial..-..1_ --_ ____--Total length____ _______________________________ Seepage Pit: Distance to nearest well_f ____Distance;,�fttom fo ndation----/__��_--�____ww�DDistance to nearest lot)ine---�__ [ � !\lumber of pits____---! _--_-__ Lining material_'7�! -_.Size: Diameter__�,T_G.............Dept h__�l�_-_f__________.___ Cesspool: Distance from nearest well------------_-_-Distance from foundation---t-------__------Lining material-_--________---____.__________-__-__. ❑ Size: Diameter-------------------- ---- ----------Depth--------- --------------------------;--------------Liquid Capacity- --------------------------gals. r Privy: Distance from nearest well__________________________________________ Distance from nearest building-_,_______-___________________-__._______. \ ❑ Distance to nearest lot lire---------------------- ------•----------------- --------------------•---------------- ----------------------------------------------------- Remodeling and/or repairing (describe) --------•-•--------------_--------------------------------------------------••----------------------------•--•- f __________________________________________________________________________________ _____-__..______________-_______-____-__--_;__________-__-__-_____________________-______--_--__________-___-_________________--____________________________- ______________________------------------------------- I hereby certify that j 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. A (Signed)-----• ""r - - ---------- Contractor BY� � - - - - --------- ------ ---- (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------ ----- --------------------- BUILDINGPERMIT ISSUED----------------- -------------------------------------- ------ DATE----- ---------- -------------------••----- Alterations and/or recommendations:___-____-.___ �o�-------------- ---------- -------------•---------------•----------------------------------•--------------- 7 - -------=---' -''-& -"-�- -------------------------------------------------------- ---------------------- ------------------------------ --------------------. --_--------------•---•-----------------------------------•- -- 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 ES-9-2M 145446 Al.... 12-54