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APPLICATION FOR SANITATION PERMIT Permit No. ..x_01_4_k (Complete in Duplicate) Date Issued Applica4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 4 JOB ADDRESS AND LOCATION- - . ..... , le- Owner's Name--------•--• &Z4--t-A -- -------------------------------------------- Phone----------- --- Address----------------------tL'.6-t------ ...2,-3--4---i------�0 _- --------------------------------------------------------------I----------------- Contractor's Name-------------------_------- -1-1---- ----------------------------------------- ------------------------------------------------- Phone----------------------------------- Installation will serve: Residence r'�A�partt House E] Commercial [] Trailer Court L] Motel L3 Other E] Number of living units: -1---- Number of bedrooms-3--.- Number of baths ---/__ Lot size �Q�__�-_��-�____________________________ Water Supply: Public system Ej Community system El Private Depth to Water Table I_ ft. Character of soil to a depth of 3 feet: Sand [-] Gravel El Sandy Loam El Clay Loam El Clay [I Adobe 0 Hardpan ❑ gPrevious Application Made: Yes E] No New Construction: YesNo9 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----60----Distanc from founddion------ b-___--Ua erial - - I ------- -- ------ + Capacity... 400 No. of compartmerifs---- —------- ---- depth.._ ------------------ ---- ----------- I Disposal Field: Distance from nearest well...w570...Distance from f-oundatign----L0........Distance to nearest lot hpe___-_5......... Number of lines---- Length of each 1ine----- -----------(----Width of trench._____;�__4------ - - Type of filter material_---�P�Depfh of filter material___... ......Total length----------- Seepage Pit: Distance to nearest well_______.____________Distance from foundation--------------------Distance to nearest lot line__.___________.._ ❑ ine----------------- 171 Number of pits-------- ------Lining material---------------- ----Size: Diameter-_---------------.----Depth--------------------------------- Cesspool- Distance from nearest well-________________Distance from foundation Lining material-_---______-._____._____________.___. p Size: aterial-- ------------------------------------- Size: Diameter------------- ---..Depfh------------------------------ --------------- ------Li uid Capacity----------------------------gals. Privy: Distance from nearest well......................________._._.--.____-._.._Distance from nearest building------------------------------------------ ElDistance to nearest lot line---------------------------------- -- -------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----- ---------- - ------------I-- ---------------------- ----------- -------------------- ........... --------------------------------------------------------------------------------------------------------------............I.....,-------------------- -------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------- ..........7,----------------------- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- I"hereby certify that I 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 Lcical-Health District. (Signed)----------_ -- ----------------------------------- -----------(Owner and/or Contractor) - -----------V� By:--------------------------------------------•------- - --_--------------------- ----------------------------------------------(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 APPLICATIONACCEPTED BY------------------------------------------*- -------- ------------------------- DATE------ ----- ------ --- ------ ----- REVIEWED BY-------------------•------------- ----- --------------------------- DATE--------------- ----- ---- ---- -- 0 r" i"' -t DATE------------------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------- ------ -- Alterations and/or recommendations:---------- --------- --------................. ---------------------------------------------------------------7-------------------------------------------- -------------------- ---------------------------------------------------------------------------------------- ----------L---------------------------------------------- ---------- ------------ ------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------- --- -- ------ --------------------------------------------------------------------------I---------------------------------------- --- --- ------------- ----•---- -- ------ ------ FINAL INSPECTION BY:..____ — - Date..---- _ ate.-------------------------------------------------5--,--- -------------------------------------------------------- - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 014 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9 145446 ATWOCD