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APPLICATION.. FOR ,SANITATION PERMIT - t Permit No. (Complete in Duplicate) Y q Date Issued This application -- � ---�f-•--�___._�__-__.�"`µ{o Appiica4ion is hereby maide to the San Joaquin Local Health District for a permit to construct and in _ is made in compliance with County Ordinance No, 549 stall the work herein described. JOB ADDRESS OC TIO?'11W {, - --- Owner's Name------ - --•1----�/----- �--- ,,,, ------- ------------------- --- -1�._ .- __ Address P- : ---�-1�--•---•------•------------ •-- - --------- ----- Phone ---•------- -----•------------ •------------------------------------- Contractor's Name_------_--•- � Installation will serve: Residence --- -• --- 0--------- Phone---------------------------------- Number ---------------- ---- Apartment Hausa -- --""____ _ ❑ Commercial Trailer Court Number of living units: /---"" Number of bedrooms ______-" rl ❑ Motel ❑ Other ❑ Water Supply: Publics stem Number of baths -------- Lot size __ _.___-_-" Y ❑ Community system ❑ _Private- F Character of soil to a depth of 3 feet: Sand Depth to Water Table -_: ft. Previous Application Made: Yes Gravel ❑ Sandy Loam ❑ ClayLoam ❑ No New Construction: Yes' ❑ Clay ❑ Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No ❑ (No septic tank'or cesspool permitted if public sewer is available thin 200 feet. Septic Tank: Distance from nearest well__/�� 'Y }e = Distant from foun tion_,"" ____ _. No, of compartments." - V y -------Materi ------------Size---- �5--- �t Liquid .depth_----- -- - --- - -- --- --------------- ------ Disposal Field: Distance from nearest wel � ` - ---------Capacity - -�-_--.Distance from foundation.__ � p Y -------------------- Number of lines______-"" Distance to nearest lot line.�"_ -Length of each fine--------- - _ Type of filter material___- � , - ��-- - Width of firench------- Seepage �-:�" Depth of filter material""_"-- -- Pit:. ------ Distance to nearest well � - Total length___.__." �,� -40- �- "�Distance fro fo ndation___.__.f", ._..D' ante to nearest lot line-____ Number of pits-__ I_ {------------Lining material____- mtSize: Diameter--_-- _ Cesspool: f . .QRS -"---� ______ ❑p Distance from nearest well____"'" "._ _Distance from founc�ation_�------------------y Deptn �_ .. Size: Diameter.------- - Lining material-------._- ` Depth---- I Priv r --- -----Liquid Capacity i «! Y Distance from nearest well' ------------------------------------ Fl -` ---------------ga -- .�,,, -------- ---Distance from nearest buildin ❑ Distance to nearest lot line__- _____ • ----•-------------------------- Remodeling and/or repairing {describe):___.__ _ �d . a "*. ---------- -• ------------------------• ----------------- { •--------- ---------------•-•-- ------------•------------- _ _ _" "__ ""-.-_""- hereby certify that I hav ------------8 i -----------------------------•-------•---------------------------------•----------- ordinances, State laws, an p pPlication and that the work will be done in accordance with San Joaquin County s and Fe ui i s of the San Joaquin Local Health District. (Signed) f� r ----------------------------------- --------------••--- = --------------- By:------------ i e F . (Owner and/or 3 I Contractor) (Plot plan, showing size of lot, location of-system in relation to wells, buildings, etc., can(bele}la placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.___--_-"-__ REVIEWED BY.---------- - - - --- --- DATE---- 1- BUILDING PERMIT ISSUED - DATE Alterations and/or recommendations:__________"______- DATE •------ --- -• - ---•-------------- 4 --•-------•-------------------- --•_•-- __• "----------- 4 _____--"----_---- .---------------------------------------.-__-._.s_:_."-_-. --- ____ ______________________ ______________________ ______________ FINAL 'INSPECTION BY; --_- -Date------ -" r - ----•------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street Stockton, California 132 Sycamore Street 814 North "C" Street �=s, Lodi, California Manteca. California Tracy, California E5-9=2M Revised W-210o