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V 77 f 1' APPLICATION FOR SANITATION PERMIT Permit No_ ________________________ - (Complete in Duplicate) Date Issued ---__________________ 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,CV�Fr•/J Woo1e er/s 67"C,G el-I JOB ADDRESS AND LO ATION..�>._e_I��ch------!�=1'�- �-Ie 1. 5x- s Owner's Name--- J ?s .--- - - ----------------------------------- ---------- - Phone -- ... - -------------- ------••--•-Address-------- -•----- ------ Contractor's Name---ft,-. ------- C--`-----=------••--------------------------------------------------------------=----------•- Phone----------------------------------- Installation will serve: Residence B Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living unifs: __- __ Number of bedrooms _21Number of baths .__.l._ Lot size __ �P-Q_--___X._6�'_ _f _�__________________ Water Supply: Public system ❑ Community system ❑ Private [9 ' epth to Water Table -------- ft. Character of soil to a depth of 3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe [P—Hardpan ❑ Previous Application Made: Yes ❑ No N___lIew Construction: Yes [-�lo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . Septic Tank: Distance from nearest well_.,;6_U-."_Distance from foundation...... .....Material-__e_.e--p--- —---------- ' l No. of compartments----3 (rc�_ -----S11ze.��1-4'_f .- Liquid depa h------4.4? --------Capacity---- ------ Disposal Field: Distance from nearest well----t`J_ _`.._Distance from foundation___7�-------Distance to nearest lot line---- .r-. Number oi'lines_____________l__ - Length of each line--------- �x_____.__.Width of french--------- ................ Type of filter material----/_-_"J'--._Depth of filter material----_1_e-`_'___.Total length-_-____�__i%-------------------------- See�pa.,g/e Pit: 'Distance to nearest welL_1.4_O-e---_Distance from foundation----74_T--_.Distan! to nearest lot iine____p_--__� E Number of pits.._____._________-Lining material___ �_�__3�^:Size- Diamete r____��..._.. ___.Depth.__ _--_________ Cesspool: Diistance"from nearest welt-----------------Distance from foundation................ Lining material—---------------------------------- Size: --_______;____.._-____________-_.Size: Diameter----`---------------------- -------Depth--------------------------- -------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well___________ __ ___ __ _____________--__Distance from nearest building-_---------------------------------------- F-1 -----__-__--------___._.❑ r. Distance to nearest lot line_______________ _____ f Remoodelin��g� and/or repairing (describe:-- �y' Yy�¢� / � ! �----- - --:'_-------g----- ,C- � --------- --C--------------- -------------------------------------------------------------•--------- --------------- ----------------------------- ------------------ ---•---------------------------------- •-......-----------•-------------------------------------------•---- ------ ------ ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San.Joaquin Local Health District. A '� rSl (Signed)--------- --- - _41c-----------�------------- --------------- ---- •- ----------------------------------------------- - .( caner and/or Contractor � s By:. (Title) buildings, etc., can be laced on reverse side (Plot plan, showing size of lot, location of system in relation +o wells, g , p ). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------t -------- -------- --- - ----------I-------------------------------------------- DATE-------�------------------ - --------------------------- REVIEWEDBY-------------------------------------------------- ---- ------------ ---------------------------------------------•-- ----. DATE-------------- BUILDING.PERMIT ISSUED - DATE ----------- �- ------------------------------ Alterations.and/or recommendations: -----------------•------- ------------- �--- -- --- ...... --------------------------- ------ ---------------------------------------------------•-•-� - = __ - --------------- - - - ---- -- •-- -" - - --j-------- ----�=-----------------------------•-•-------------------.:.------------------------------------------------------------------------"--"-- sa FINAL INSPECTION BY:------ = S----------------------------- --• 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-4-2M 145446 ATWCDE 12-54 '