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rmit:No. _ APPLICATION ;A FOR SANITATION PERMIT �e (Complete in Duplicate) i . Date Issued Applica+ion is hereby made to the San Joaquin Local Healt istrict for a permit to construct and install the work herein described. t This application is made in compliance with County Ord' nL��o. 549, JOB ADDRESS AND LOCATION----- ------ ------ ---------- Owner's Name -s .r� �1:= .f+ocu )---- ---------------- Phone ----•-�----•---- Addressa rr ------ -'--.--------- - ------------------♦♦--:----•--------------=---.......---------------•----------------------------------------- Contractor's Name_"""_".....-""_" I�t/Ls�- �.,. ----------- -------- -••------ ------ --•----------------------------------•-------- Phone---1 60�- ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ "``"*:F� Number of living units: ---I- Number of bedrooms !✓Number of bafihs -_/--- Lot size -_-_ -__~" �_Q > Water"Supply: Public system [Community system ❑ Private ❑ Depth to Water Tableffvft. Character of soil to a depth of 3 feet: Sand Q, Gravel ❑ Sandy Loam ❑Clay Lo m E] Clay ❑ Adobe �arclpan ❑ Previous Application Made: Yes ElNo [ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 �- (No septic tank or cesspool permitted if p is sewer is available within 200 feet.) ^- Septic ank: Distance from nearest well--. -Distance frpm fo�ndation----/P__-"--.Material--------4r_._""""------------------ --�� No. of compartments Z<----""-..____Size-_ k4 for `� P - --- - Liquid depth Capacity" A91 .r Disposal Field: Distance from nearest well"."..............Distan�e roam foundation____--_----_------.Distance to nearest lot line.__....__ , ❑ Number of lines-----------------------------------Length of each line-----------------------.------.Width of trench------------------------------__--- Type of filter material-------------------------Depth of filter materia----------------------- length------------------------------------------ -II Seepage it: Distance to nearest we€E_.�___-__--."."._..""Distance m f undation_,f-•-Q_"""------Distance to nearest lot line------+�_------ Number of pits----r----------------Lining material----------- -- -----Size: Diamefer--- --- --" --------"""--- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- -17 ❑ Size: Diameter--------------------------------------Depth-------------------------------------------------Liquid Capacity----------------------------gals. 0 0 t Privy: Distance from nearest well----------------------------- _` .---------------Distance from nearest building----------.-------------------------_----- ❑ Distance to nearest lot-line--------- ------------------------------------------------•----------`-----•---------------------- - Remodeling and/or repairing (describe): ----------------------------------------------------3------------------•---------- F----------------------- -----------------------------------------------------------------------------••----- ---------------------------------------------------------------------•-------------------------•----------••---------------------------- --- ---- ----------•-------------------------------------------------------------------......... -------------------------------------••--------------------------------------------- ------ i -----------------------------------------------------------------------------••-------------------------------- I hereby certif t at I have prepared t ' application and that the work will be done in accordance with San Joaquin County ordinances, State w , and rul and reLans he San Joaquin Local Health District. (Signed)---------------------- - --------------- - - ----- --- -------------------------------------- ---- Contractor}By:------------------------------------------------------------------- - ---- ------------ - ------- ------------- ; - (Title} (Plot plan, showing size of lot, location of system in relation wells, buildi s, etc., can be placed on reverse side}. , 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------ ------------------------------------------------ -------------------- DATE REVIEWEDBY------------------------------------ ------ ---------------------- --------------------------------------------------.- DATE- --- BUILDING PERMIT ISSUED---------------------- -"" -- """"-- DATE.............."---�- Alterations and or r mme dations- -------- ----- ---------- - -------- --- ----- ..".,,,,,a:-...__ - ---------- -----".-.-.-"----------'----" ". ...." ----------------------------- ' l-.. . -". .-"" _" _. - "__.-.__.. -------------------------------- -------- - ----- --- ------ -_--------- ----------------------------------------------------------------------------------------...----------------------.--------------------------- 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 I4a feta, California Tracy, California ES 7-2M 145446 AT—D 12.54 .-