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Al APPLICATION FOR SANITATION PERMIT Permit No. ....................... 1 (Complete in Duplicate) 61 -`� S � �.__.... ..._ Date Issued -- - - ---... Applicaa-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 Count Ordinance No. 549, JOB ADDRESS AND,=ATION.._- ! / Rf' 7-1v ------ .. .. . ' 5 1 / 'Alp wr Owner's Name 1 ..-....- - ----•---_1FI_.711V -Q!f�_J` .�7 Phone Address ---•-- ' 0_Z_V_'-- ----------------------- Contractor's Name----x 1 � _1 ...L. / C------------------------------• --------------------------------- --------- --. Phone----------------------------------- Installation will serve: Residence [Wpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f . Number of living units: Number of bedrooms �3_ Number of baths .._C__ Lot size _ __-9<--/��_-_---__----•__---- Water Supply: Public system ❑` Community system ❑ 'Private Depth to Water Table � ft. Character of soil to a depth of 3 feet: Sand [:] Gravel E] Sandy loam E] Clay Loam I-] Clay E] �t9 Adobe ardpan ❑ Previous Application Made: Yes ❑. No Q(]/TVew Construction: Yes EJ—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200 feet.) ' Septic Tank: Disfance*from,nearesf well_-:7.1:..__Distance from foundatio _._jvpMaterial_ ________. p ty.__Kr_______________ No. of compartments......SGL)_ .-.-_Size_ --�'�_ 6 ��_Liquid d --------ar a-0 ! i D'lsposal Field: Distance from nearest well,_7 . _Distance-from foundation____0 p th._.Distance to nearest lot line�__ _______ ©� Number of lines------- Length of each line: d'__1j447 Width of trench------- _u_11--------------- Type ______________Type of filter material----/ _____ ___Depth of filter material----��._______J_.Total length-------- Seepage Pit: Distance .to nearest well_VC3 0 __---_Distance from foundation_---.�--_--_-Distance to nearest lot line__..____-____- Number of pits...... __--___-Lining material___/_ _!�ize: Diameter__3 -__.___..__-Depth---.-...Ps ---------------- i r Cesspool: Distance from nearest well------------------ from foundation--------------------Lining material------.-------------------___________- ❑ Size: Diameter-=-- - -------------------- -----------Depth----------•-------••----1---------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-______________ 1 Distance from nearest building .-_----_--_-.-. ❑ Distance to nearest-lot line-------- "_________I.__ - - - ,I - /X�'t°��------- __S- a "� --•--------------� _ ------•-------------- Remodeling and/or.repairing.[describ ):_-_-- ---_:_ c� , _ ° ----------------------------------------- ------------------••--------------------------------•------------y- - - ----- ------ -------------------- ------••------------•------------------------------------------------------------------------------------------------------------------------------------------------ Ihereby certify that ! have prepared this'application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and: regulations of the San Joaquin Local Health District. - ` - ----------------------------------------- ------------- (Signed)---------- ---- ✓__ e�!__-- ----'--- -- '._ (O er and/or Contractor) By:. - ----------------- ------- •- -------------------- -{rile) (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on rever e.side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --------------------------------------------------------- DATE---- --- •-•--------------------------- REVIEWEDBY------ ---------------------------- -- ---- - --- ---------------------------------------------------------------- DATE--- ------ _..-..------._.... BUILDING PERMIT ISSUED------------------ -----� ----------------•--------------------------------------- DATE-------- - ------ Alterations and/or recommendations:-------------------'------=- -- - -----------------------------••----------•• \ ----------------------- ---------------�-------------•-------- --- ---------- ------ ----- V. FINAL -INSPECTION BY: r ''`r -�--`-�-•------------------ --- ---------- Date------• - ---- ---------------- ' SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-'9-2M 145446 ATWLIOO 12-54