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tires r APPLICATION FOR SANITATION PERMIT Permit No. ________ � p (Complete_in.:D plicate) Date Issued __� �. � �_. fApplica+•ion is hereby made to the San Joaquin-Local Health District for a permit to construct and install the work herein described. f This application is made in compliance..wifh County Ordinance No. 549. JOB-ADDRESS AND LOCATION_[.... I -- ---- - - i""----"- -� -- ------------- �k --------- JOB-ADDRESS AND Name pp .. -- -----•------ ------ ------. Phone y.. ----------- p-----�� 7� r..�z---------------- - ---------•----- Address_ -----------------------------------------------------------••-------------------- . Contractor's Name---------------- ------------------------- --------•----------------------------•----. Phone---------....------------------- Instaliation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __-�. Number of baths ----/! ize ____. --p-� --------------••- Water Supply: Public system ❑ Community system [I Private Fey Depth to Water Table Z4"ft. J Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam ElClay Loam ElClay 11Adobe 11Hardpan ❑ i .- -Previous-Application-Mad e..,;Y No x-_ New Construction: Yes .No.❑..._ - -•- -4---� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 714- l -----0 ._.Distanc from found t�.___.Mat " iaJ_-..._ ..-_.-.--._-. Septic Tank: Distance from nearest well No. of compartments_--_----F ----Size_ _1�-.x- -•-Liquid depth------- --- -.Capacity... ._-__.- i X71 -- p Y... // 7d_---_.Distance to nearest lot line--_426 _ Disposal Field: Distance from nearest well___.._(p..Q.._DIstance from foundation._____ __ �� Number of lines------- - -- S~ -_ Width of trench.----�-�------------------ �----------- -Length of each line---- - --------- Type of filter material___��__ ...-_._ Depth of filter material------f'...-,.....Total length-------- ------------------------- 1 Distance from foundation....._.___ ._.___.Distance to nearest lot line----------------- Seepage Pit: Distance to nearest well-.-.------__ _ ❑ Number of pits---------------- ---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 building----------------.--__-____.___. --------- ❑ Distance to nearest lot line-------- --------------------- -----------------••------ ---••---------- ---=---------------------- ------•------•---•-----------_ 1 Remodeling and/or repairing (describe)------------ -__ -- ---- ... .......... -------- -- --------------------- ---------------------- R------------------- ---I--------- 1 ' lt_....._. r,. � �� . � ;€. - -=- --- -- ---- - --- - I hereby certify that I have prepared this application and that the work will b1 dene in accordance with San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District, 5i nedT/41' -------------------------------------------- * - -g_ -. �{Own /oG.ontractor ( ) By------------ -- --------------------- --------------------------------------------•Tale (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------- -- ----- ---- - --- -------- ------- DATE--------------------- = >. REVIEWEDBY----- -----•------------------------------------ --------- ------- DATE--------- =?` ------ ------------------- , BUILDING PERMIT ISSUED. -------------- DATE-------------------- ------ Alterationsand/or recommendations------------------------ ---- -- ....• -------------------------------------------------------------------------------._...---------------•--••- Y ----------------------------------- •-•----------aef�7�------------------------------ --------------•---------- ----- ----------------------------------------•------------------------------------••---•------- -- ----- ---------------------------•------------ ---- - ---------- ---------------------------- ------------------ ------ ---------------------------------v-------- -- ----•-- ---------------------------------fi --- -----------------------•-----------.__---------•-----...-----------------------•---------------------------------------•--- FINAL INSPECTION BY: �.,_ Date. ' " -----------------------• ;' a e , 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 4� E5�9 145446 PTWOOO - X ��