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- f� APPLICATION FOR SANITATION PERMIT Permit No. ._/Q-3-_Z`.�.. A7\ (Complete in Duplicate) Date Issued ----��/s�- k - T Applica+ion is hereby made to the San Joaquin Local Health District for a per mit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIQN..--.^. .+'►�[-_''------- ------------- Owner's Name -r_. = "!� ---- -•---- ------------ Phone Address. ---•--•. ----- ---q..... --- ---- ------ --- - ---•--------- ------• •------------------------•---------------------------- Contractor's Name------•---•------•----------------------- ---------- -'"--- --•------------ -----------• ---------------------- -•--------•-- Phone..--•--------------------• - Installation will serve: Residence Apartment H. use ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ -Number of living units: _--- Number of bedrooms ------- Number of baths -------- Lot.size --------' '...." - Water Supply: Public system ❑ " Community system ❑ Private Depth to Water 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 K New Construction: Yes K No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -- Sep#ic Tank:-+ �:Distance from nearest=well`�r---- ❑ No. of compartments------------- -----------Size--------------------------------Liquid depth--------------- - --------Capacity------------------••--- Disposal Field: Distance from nearest well-----------------Distance from foundation-------------.------Distance to nearest lot line-----------.-.--. ❑ Number of lines__.. -----_--Length of each line-------------------------- ---Width of french.---------------_------------------ T enoT filter mat t material -. Depth of filter material--.-...-..--------- -Total length----------------------------------w_- Yp r � II f Seepage Pit: Distance _ --Distance fro foundation----�h-b--------Distance to nearest lot Pne-----€!�---__ ` Number of pits--------I------------ ,aterial-Ir~�� y5ze: Dia etas--- .-----Depth----- -t�; ---_-----.-----• `J Cesspool: Distance from nearest well-----------------Distance from foundation' -......_ Lining material ----------------.------_-__--.---_-. Size: Diameter--- ---------- ----------- Depth------------------ --------- ------ ---------Liquid Capacity------ -TM ---gals. Privy: Distance from"nearest well -- ------------------------------------------Distance from nearest building-_-_--.---__-.------___-___---.--------. ❑ Distance to nearest lot Iine---------------------------------------------------------------------=------- -------------------------------------------------------------- 4 r r ..._- Remodeling /or repairing (describe] ; `'" ' -------- -• -----------------------/I--------------------------------------------------------------- ---------------------------- •---------------------- --------••-----•------•-------••-----=------------•---------------------°------------•------------------------•--•--- ------------------ ---------------------- - I hereby certify that l 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) �'`-- G� -/ '/,n' �'! - ------------ r -------- (Owner and/or Contractor] ------------------------------------------------ By:-------•---••---------------------------- - --------- ---- _(Title) (Plot plan,:showing size.of lot, location of system in relation to wells,,'buildings, etc., can be laced on reverse side. FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY _ --- -------------- ---------- DATE DATE----------- - p ---------- ------ REVIEWED BY--•-----•----- --=-------------------------- - T i - BUILDINGPERMIT ISSUED-------•----_------ �- - -----------------'.. DATE.------------------------------------------------- Alterations and/or recommendations: ------------ -------------- - ------------------------- -----•-----•---------------•-----------------------------------------------------------....------------ ----------------- ---------------- -- -------7------------4---------------- - -FINAL INSPECTION BY:. SAN JOAQUIN-LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California Es-9 i95446 ATWOOO