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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ��Applica4.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 N . 54L C JOB ADDRESS AND IOCATION ---- . ----- -- t (S ------ Owner's Name - -Z71 --- ---------------� ------ --------------------------- Phone----- ------------------------------ Address------------------•42-��--------- F Contractor's Name--._tIPW�_-1 1-.1-- --. "`�• Phone.-/-Vw. f ord Installation will serve: : Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths ._.----- Lot size ----j44___ _______j- Water Supply: Public system DC-CAmunity system ❑ Private ❑ Depth to Water-Table -_A�Pft: Character of soil to a depth of 3 feet:, Sand [❑ Gravel ❑- Sandy Loam ❑ Clay Loam ❑ Clay 0 Adobe B, Hardpan ❑ R~'l Previous Application Made: Yes E] No � k New Construction: Yes JZ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: „--$istance from nearest well __-______.___Distance from foundation--------------------Material_______:'_y___________.______•_.___.__.___-_-__. of compartments--------------------------Size.------------------ --•--------Liquid depth----------- ------------- Capacity--------- ------------ II Disposal, Field: Distance from nearest well--_4/07xQ—]istance from founclation.._`o �__-__-Distance to nearest lot line.._ �_ Number of lines l___.__ �� .._ Length of each line_______/.5 -- Width of.,trench__ ___ _ _____________ - � Pi--- - - � ---------------------- t Type of filter material---�__g,.__....5 —Depth of filter material___--__.____.___Total length--:-,-/-; _ ------------_______ Seepage Pit: Distance to nearest well------ ---------------Distance from foundation_________-__----•__.Distance to nearest lot line----------------- ❑ Num6er of pits-1------------------Lining material-----------------------Size: Diameter------_--------_-------Depth--------------------------------- Cesspool: Distance from nearest well-________ ______Distance from foundation---------------------Lining material—____-_________---_________--. ❑ Size: Diameter--'------------------------------------Depth-----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_________________________ ' -----------------------Distance from nearest bui!ding------------------_----- ❑ 'E` Distance to nearest lot cine_________ ______............ i- --- ----------------•--------------------:------------------- { Remodeling and/or repairing fdescribe)------- -----------------------------=---------------------------------------------------------------------------... ' I -------------=-••-------------------------------------•---- - --•---- =•---------------------•--------------------•---•------•-------------------•----•-••---••-------- •---- ----------------------------------- ----------------•--•--F---=--------------------------------- - --•--•---------------•-•--------•-------••---------•-------• --••-------------•----•---------•--------------------- 4 I hereby•certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, and rules and regulations of the San Joaquin Local Health District. __ _ . (Signed)-------------- ---- ----- -------- -- ---- ------ ---------------------------------------------------------.:--------------(Owner and/or Contractor) By:.. -- ._ f (Plot plan, s owing size of lot, Iota ion of system'in relation to wells, buildings, etc., can be placed on reverse side). • l � i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ��4 --------------------- DATE------- ' - ------------------------- ftEVIEWED [3Y - ----------------- i------- - - DATE--------- -- t BUfLDING PERMIT ISSUED. DATE ------- -- _• --- ------------ ----- -- --- ----------------•-•---------------- Alterations and/or recommendationsi._.__________________ I -------- ----------------------------------------- _____ .:..______ --------------- ---------------------------------- _ --------- _ -..--•------------------- -------------------------•--•-------------------- L----------------- ------- ------ ---------- ---------------•--- ----------------•--•---------._. .. .-----------• --------------------------------------- ---------------------•-----------------------•----------------- j ----------- ----------=------------------------------------------------------------------ -------------------------------------- ---------------- FINAL INSPECTION BY:--=- = - Date---------- I -------------- SAN - -- . :SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 19 46 ATWOOO 12-59