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(� APPLICATION FOR SANITATION PERMIT Permit No. -�----- (Complete in Duplicate) S1��S7 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. JOB ADDRESS AND LOCATION------o---- 6__r,-------�•-------L/_--t -�1. -- �/ CJ - ---------------•---------------- Owner's Name..-__�f7 9xx/----•------- --------------- -- ---------------------------------------.-- Phone------------------- Address-----------------:,.5_ ..t2v.C--•---••------------------------------------------------------------ ........ Contractor's Name---- !`' -e�c--`--------------------- - Phone----------------------------------- -- 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 �' 1_t.C'-_r____________________--_- Water Supply: Public system 91._�Ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E;--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-----------------Distance from foundation--------------------Material--------------------------------____----..______- ❑1a(j 51#1,3�No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ------- Capacity------ ---------------- Disposal Field: Distance from nearest we€!................_Distance from foundation--------------------Distance to nearest lot line__-.____________ ❑ Number oflines-----------------------------------Length of each line-----_-----------------------.Width of trench----------------------------------- Type of filter material________________________Depth of filter material-----------------------Total length_-__________-.---__.__.____________--__-- Seepage it: Distance to nearest well--- Distance from foundation___!J__/_.-..Distance to nearest lot line____ ~_---- Dumber of its-___..../___..._.__Linin mate rial-_A9�_�'C__X_Size: Dia'meter__________.�.._-. + p g .7.� Depth. s Cesspool: Distance from nearest well-------------__Distance from foundation----------------------- Lining material------------------------------------- ❑ DeptSize: Diameter-------------------------------------- h-------------- - -•--- - ---------------------Liquid Capacity----- --------------•------gals. 1 Privy: Distance from nearest well-----_____________________-____---.-_--__:__._._Distance from nearest building-------------.____-____...______------- ❑ Distance to nearest lot line ----------------- ---------------- ----------------- ------------------------------------------------------•----------------------- Remodeling and/or repairing (describe):_____ r „-__ / ` - ---------- ------------------••---• ------------------------------ -------------------------------------••---------------------------------------------------------------------------------------------------------------•----•------------------------------------------------------------------ -------------------------------------- ----------------------------------------------------------------------------•--•--------------------•-----------------------------------------•--•--•---•------------------------------- ------------------------- ------ -------------- ------•--------------------------------------------------------------------------------------•-------•--••---•- --------------------------------------•--- ------------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State L, ;J rules and regulations of the San Joaquin Local Health District. (Si ned 1,:514 I---------a 9 )------------- --- - ---------- ---------•-------------------------------- ( ner and/or Contractor) By.......- - --------------------------•--•- --------------(Tifle) -------------- ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I, a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- - ------ ---- --------------- -- ---------------------------------------- DATE---------- --- - ------------------- ------------ REVIEWEDBY------------------------------------------- - - ----- -- ---- - -------- ------------------------------------------ DATE---------=--- BUILDING PERMIT ISSUED----------------------------------- -------------------------------------------------------- DATE-------------- �� ---------------•-- ------ Alterafions and/or recommendations_________--------_________ ��-Q----------------------- ------------------------ ----------------------- -�= - �`-- `r^ 10----- ------------------------------------------------------- ----- ----------- ----------- --------- -------------•-------•--- ---------------- .------------- ------------- ---------------------------------------------------------------- --------------- FINAL INSPECTION BY:. 1 _ � �41 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 Er----9—ZM 145446 ArWpdn 12.54