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APPLICATION FOR SANITATION PERMIT Permit No. _._ .... ..�._..... (Complete in Duplicate) G Date Issued .-_ 7 5 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. JOB ADDRE A D OCATION_ `:cruCf� -- Via= �v a 1�#- ,tea f'c.-4 ct 1 r _ ------------ �fione Owner's Nam ..�`�'_ � � _.----L-%---�-z�=a-•�---�- �:_ � �- Address-------------- �2� Ie, - �- �� .�� r � � . � ��_�� --e� - # ' ----' Contractor's Name..----- --/�_.�!t-•c-�-: ..---•--- • - -------------- -------------------------------------- ----------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑• Number of living units: __ --- Number of bedrooms .,j_.-. Number of baths ---to size ___ _.��-_.. ________________________.-__._ __-_-.-,_.__ Water Supply: Public system ❑ Community system El Private [Depth to Water Table T,�_ tt. ' Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay LoamRClay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes 2-'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS- ' {No septic tank or cesspool permitted if public sewer is available within 200 feet.) -' �h d '�,4. Septic Tank: Distance from nearest wel 3z___-----Distance from foundation. .................Ma r I__._ _.__...___--__ ._.......... ___.._- -... p�� No, of compartments---- - ------------- Size _� __ �'_ `_-___Liquid depth_-- ;___�°--------Capacity--,?..��___--- Disposal Field: Distance from nearest well-7 r.....-Distance from ourldation___= _ ..Distance to nearest t line_______ __. ❑/ Number of lines----_-�.__..... ..... __f_ Length of each line.....................Width of trench_...___`f__..._.._.__.___. f Type of filter material-_ _�f 7-.Depth of filter material-__._� ;_fi---.Total length-- ----_____-_•-_-_--__.- � .� Seepage Pit.- Distance to nearest well_./��.- ..-Distanc om foundation...- �--- r n�' to nearest lot line_/P___----_ Number of pits.--/.----- --.---Lining material .____-_Size: Diameter _-._____Deptn_. .sy__.___._.__ f Cesspool: Distance from nearest well----------------- from foundation.---.--------------Lining material-------------------------------------. -Size:._Diameter�,.-;---� :� --- ------Depths -------- .. f .mow..,.,. - Privy: Distance from nearest well.......----------------------- ------------------Distance from nearest building--------------------------------. .--.---- ❑ Distance to nearest lot line--------- --------------------- ------ ---- ------------------------ Remodeling ------------ -----Remodeling and/or repairing (describe)---------- ----------- ---------------•---------------•---••----------------------- # \ --------------•--------------•-------------------------- `,- -----------------------------------------------------------.------------------------------------------------------------------------------------------------- ---�-------------------------------------------------- ------------ --------------- --------- ------------------------- application and certy that I have prepared the application and that the work will be done in accordance with San Joaquin County ordina a 5tay�s, and rules and regula)'%nsof the San Joaquin Local Health District. "`` ------ ----- --- -------------- By: rre r Cantractor� [Signed)------- - - --s--------------=--�- - .• B • ------ --------- ----- ! r ATitle)_ � �------. (Plot plan, showing size of lot, location of system in relationwells, can -.- be paced on reverse side). FOR DEVARTMENT USE ONLY APPLICATIONACCEPTED BY-----------°- - ----- - -- --- --- ------------------------------- •-------------•-•-------- DATE-.._C——----------------------------------------------- REVIEWEDBY-------------------------------- - -------- ---- --- --- ----------------- ------------------------- --------.-.- DATE--- -----• --- BUILDINGPERMIT ISSUED------------------ ------- ------- - ----------------------------------------------- ----.- DATE----------------- --'. --------------•---------•---------- Alterations and/or recommendations:.....__._._... �X- ----------- -------- - ----- --------------------------------------------------------------1----------------------- ----------------•-----•-•-----------•-------------------.... - ------------------ -- -- i FINAL INSPECTION BY:--- .•5 --------------------- Date. --- - --- 's- SAN - JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streof 300 West Oak Street 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWOO❑ 12-54