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A4 APPLICATION FOR SANITATION PERMIT Permit No. .-.7-� a- ! (Complete in Duplicate) � r Date Issued .__.��t=-�'_ A plica--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 ADDRESS AND LOCATION k . .....f ..If _ -f�_ -57 --------------- - Owner's Name------- U 1 iq--------- 4?_ !_h/_ ---------------------- ------------- Phone------- ------------•--------------- Address-=------------`ter A Contractor's Name -�Z - - - S�J - - -------- �� -- ------------------------------------ •-----•-•-----------••-- ------------ Phone_ Installation will serve: Residence [}—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �i Number of livingi units: ___-%__ Number of bedrooms __ Number of baths __I__ Lot size __.__.._ ____X_..- vs --------- ----------__._ Water Supply: Public system Ek�Ccimmunify system ❑ Private ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe B--Hardpan ❑ Previous Application Made: Yes ❑ f No [tom -New Construction: Yes ❑ No 9---- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t � 1 Septic Tank: Distance from nearest well--;-.-.___.... .--Distance from foundation--------------------Material__-__--.._.----.-.-.- ---_ -__-_-----_-_.__-_._--. ( rN --------CapacitY❑� oPartments........................ Size------------------------ Liquid dePth_.__- ------- Disposal Field- � Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----------------- ' ❑ ,�j(#Wj '1/Number of lines--------------- -------------------Length of each line------------------- ----------Width of trench----------------------------------- c Type of filter material-------------------------Depth of filter material----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well.. -1l�_!1,otK-Distance from foundation-_..�4____._.Distance to nearest lot line--. U.--_-, [� Number of pits-°.----- ----------Lining Diameter--�'3_........... Depth--------------------------------- Cesspool: - ------___________._._Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------------------------- T\ ❑ Size: Diameter---- ---------------------------------Depth----------------------------- ----------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest we]-------------------------------------------------Distance from nearest building----------------_-_-_----___-_ ❑ Distance to nearest lot r line---------------- _ ------------------------ --------------------------------------------------------------------------- Remodeling and/or repairing (describe: d4 v --------------------------------- ---•---..----••------------------------------------ ------------------------------------------ --- - - --------------•--------------------------------•----.-----•- --- i I hereby certify that I 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) fel f� ��'f/e-� (Owner and/or Contractor) B • ��` 'J-�`------------------------------- - Title --- `------------------------------- Y• -- -- ------ (Title) (Plot plan, showing size of lot, loca+ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------- -- -- -------- ------------------•--------------------- -- DATE------ " !' REVIEWEDBY------- ------------------------------------- -------- - - ---------- DATE----------------�2 BUILDINGPERMIT ISSUED----------------------------------------- - -------------------------------------------------------- DATE------------------- Altera+ions and/or recommendations'. -- - - ------- -------- --- -- ----- .6 -- •-•-------------•-------•-------•---•----- --------------------- ------------------- rl .. _.. ------- -- - s� FINAL INSPECTION BY:... --- ------------------------------- Date------------------------ ----- ----------------------------•-•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 A7WnCD 12-54