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LICATI N FOR SANITATION PERMIT Permit No. (Complete in Duplicate) s Z- ✓� � � Date Issued Application is hereby made to the San Joaquin Local Health Distri it to construct and install the work herein described. This application is made in compliance with County Ordinan N 49 JOBADDRESS AND L ATION------ --' ----- -- ------------- - - -- ---- -----------------------------------------------------------------------------------------------or i Owner's Name---- �"�,'l = Phone--- Address " ---- --- - - ------- ------- - ---------------------------------------------------------------------------------"-------------------------------------- Contractor's -- ------- -- -- -------- Contractor's Name ----.-------•------------------------------------------------------------------------------------- Pone . Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court -❑ Motel ❑ Other El, Number - Number of,living units:.__ ____ Number of bedrooms--�_:_ Number of baths ---/___ Lot size —-----Q____________________.__-_ I Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table4_A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ NoX New Construction: YesV No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publisewer is available within 200 feet.) Septic Tank: Distance from nearest well.-_-_____-Distance froVX?/Liquid cau n ati n_ �_________.Materi I___ _ ____________ ___ ______ No. of compartments-----_,__-____ Size__> .. _ depth "___ _ -_-_.--Capacity_--_--_ _ �: Dispos I Field: Distance from nearest w1ell ._Distance from foundation_ _d-. Distance to nearest lot line___________ ' Number of lines-----------!_____________ _ ____Length of each iine________P_ _____ Width of trench_____,. p � Type of filter material__ ___ :Depth of filter material____ _ __'_'____Total length_______ ____ t`•� Seepage Pit: Distance to nearest well----------------- ___Distance from foundation--------------------Distance to nearest lot line----------------- _i } ❑ Number of pits----------------------Lining material-----------------------Size. Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------------------- 17-1 . Size: Diameter--------------------------------------Depth--- ---- --- -- -- -- ----Liquid Capacity-----------------------------gals. 1 Privy: Distance from nearest well ___.__ _ __ ___ __ ______________Distance from nearest building_---_ __ _. , _.-__ -- ❑ Distance to nearest lot line------- ----- ------r------------------------------------------------------------------------- -------------------- E - f Remodeling and/or repairing (describe):---------A --- - -----------------------------------------------------------------------------------------------------•----------- �^ ----------•---•-----------------------•----------------•-------•--•------------------•----------------•-----------------------------------------------------------------------------------------------------•----------- C7 -----------------------------------•---------------------•----------------------------------------------.-----•--.-----------------•------•------------------------------------------------------------------------------ I hereby certif that I have spared this application and that the work will be done in accordance with San Joaquin County" ordinances, 5ta a $ , and u e . nd regulations of the San Joaquin Local Health District. (Signed)--- -- ---------------------------------------------------------------- --------- -------------------- Owner and/or Contractor B ----------------------------------------=-------------------------------------------------------------- Title (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 C APPLICATION ACCEPTED BY ----=----------------------------------- DATE------- r - '` REVIEWEDBY-----------------------------------•---------------------------------------- -------------------------------------------- DATE------------------------------------ -------- BUILDING PERMIT ISSUED-----=---------------------------- ----- ---------- -- - ------------ ---------- DATE_- --------- Alterations ------� 3 Alterations and/or recommenda _____.__._____. - ___ _ _ / - -��''� -------- - - --y----- = '- = _------- _ __ _ _ _ _ ______ ------_---°_______________ __ _F---------- T& ---------- - - - "---------- -- - b----------- - --- ----- --- -- . ---------------------- ---- ---------------.----------------------------------------- t FINAL INSPECTION BY------------- -'_ - ----_-------------------------- Date---------------- ` _ ,, �1 _ SAN JOAQUIN LOCAL HEALTH DISTRICT 13o South American Street 300 West Oak Street 132 Sycamore Street 814 Horth "C" Street Stockton, California Lodi, California -.Manteca, California Tracy, California €S-9-2M 8-51 Revised W-2100