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APPLICATION FOR SANITATION PERMIT . Permit No. __ 1._�- (Complete in Duplicate) Date Issued • O 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. 1-64-A/7k y AO' JOB ADDRESS A�lVeW TION__--4- ! l - - Owner's Name-_____ .Address ----- =� ne------------------------•------ - "� 4-------------------- -- - - •--- ---•--•- Contractor's Name- ----------------------------------------- Phone_ Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms .-2—. Number of baths ._./ Lot size ______,2- -z----•-------- -- - ---•----------- Water Supply: Public system ❑ Community system ❑ Private ® Depth to Wafer Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes & No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_/aa-- --Distance from foundation__._ r �._..---.Materiaif r �---------- Capacity ----- - No. of compartments_---, *2 -------------Size4_5 -�-3-fps-----Liquid depth----4- 65 *'--------Ca acit Qv----- PY------- Disposal Field: Distance from nearest well---/l4...Distance from foundation___ Distance to nearest lot line,___.r0. Number of lines_____________ __ `1 �- --�.-��-.__-_._Length of each line------ of trench.____�_iG�_-- T e of filter material____ -------------- YP -l�____,7�Depth of filter material..__.._l_�___-----Total length--------��_�---_ - Seepage Pit: Distance to nearest well----------------------Distance from foundation___--_____ -__._.Distance to nearest lot line------- ❑ Number of pits-----------------_---Lining material------------------- Size: Diameter ---------- -----Depth------- ------------------ esspoo : Distance from nearest well-----------------Distance from foundaf on__-__.___-__._-.__-.Lining material--------..____.____.__---------- ❑ Size: Diameter--------- --------------- ----------Depth-------------- --------------- ---------------------Liquid Capacity..--------------------------gals. Privy: Distance from nearest well-.._._.____................ -------.-Distance from nearest building ❑ Distance to nearest lot line----------------------------,--------------_ - ------------ Remodeling and/or repairing (describe):______________________ -----••------------- - ; hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta a s, and ruEes and regulations of the San Joaquin Local Health District. (Signed) ---------• t`- - `. (Owner and/or Contractor) (Title)---- ------- ot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). (PlFOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ._.__.-.-_--- DATE- ' �; ---------------------------------------------------- -REVIEWED BY ---------------- ----- ---- --w'°'-•--------------- ---------------------- --------- - - DATE BUILDING PERMIT ISSUED -------- --------------- ----------------------------- -------------- ----._ DATE. Alterations and/or recommendations______________________ _ ------ --------------------------------------------------------- -------------------------------- ------------------------------ ---- ------- FINAL INSPECTION BY:.___..__-.- r ,s~ + '• - Date f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C".Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9-2M 1as446 ATWOOO 12.54