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• •APPLICATION FOR SANITATION PERMIT Permit No. --- ------- Z •� (Complete in Duplicate) y� Date Issued ___3�-4�__._. 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. JOB ADDRESS AND'LOCATION------.l--ZICr�V----..-- ---------------------------------------------------•---•----•--------- Owner's Name---- .4 0----- ---------- --------------------------------- ----------------------------------------- Phone------------------------------------ ---------------------------------- f rew Contractor's Name-- -- •--- ---- ...--• ---- PhD ne-------_`S----r2i r Installation will serve: ResidenceZ_�ar ment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms 1_- Number of baths .A___ Lot size __1s__�___ ------t_!_Q_______________________ Water Supply: Public system ZL-Caw-munity system ❑ Private ❑ Depth to Water Table SV- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No ew Construction: Yes ❑ No E - TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) ep Ta Distance from nearest well-----------------Distance from foundation--------------------Material _-----.--_-.---._..__...._____________.________- No. of compartments------- --- --------------Size------.-------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation-----------_--------Distance to nearest lot line________________. ❑ dumber of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- " Type of filter material---------- --------------Depth of filter material-----------------.-.---Total length____________-_-__.____ ______________-.._ g � Seepage Pit: Distance to nearest well. ___Distance fr�o T�ff°°undation__- _/t_.___.Di tante to nearest lot line----�------- �► dumber of pits.-----t--------------Lining material_�A0'-�--...Size: Diameter_,.__...________Depth-. 14---I------------- --.-- Cesspool- Distance from nearest well-----------------Distance from foundation------------------- Lining material----------------------------.__._____ ❑ Size: Diameter----- - --- ,-----------------------Depth=------------------ ----------------------------Liquid Capacity---------------------------•gals. 1 Privy: Distance from nearest well------------------------____---------------------Distance from nearest building--------------------------______._.______- ❑ Distance to nearest lot line--------- ------------------------------------ ----------------------------------------------------------------------------------------------- Remodelingand/of repairing (describe)------------------- -----------------------------------•----------------------------------------- .__..-------•-----•------------------------------------ -------------------------------------------------------------------------------------------------------------------•-•--------------------------------------------------------------------------------•----------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) _______________________________Owner and/or Contractor) -- --------- By� ----------------------------------------------------------------(Title)- • • •-------------------------------------------------------- ^ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i ..�, FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__________ ______ _ DATE_.___ _ REVIEWED BYy DATE ' f ------------------------ BUILDING PERMIT ISSUED---_---------- ------------ - DATE------------------ ��--• Alterations and/or recommendations ----------------- �---- ------------ ----- ------ ------------ tom -•-------------- ----••--------•------------------------------- ------------------------------------ ---- -- ----------- --- -- - ---- ----- ---- --- y ------------------------ --------------- ----------------- ------ ------ ------- - ---------------------------------------- -------------------- -- FINAL INSPECTION BY------------- 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-9-2M 145446 ATWo90 12-54