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:. �5 3 APPLICATION FOR SANITATION PERMIT Permit No. .__ __ _ 7. if, (Complete in Duplicate) 6 y Date Issued Application 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 withCountyOrdinance No. 549. JOB ADDRESS AND OC iON_______ I-f_Q------ ------ -----------• - �� Owners Name ------------------------------------ -1i ----------------------...------------------------------- o� ------- Owner's p Address7 a--------- L.t ----------- -------------------------------------------------------- ------------- -------------------------------- Contractor's Name---------- -------- --------- T---------.----------------------------------------------- Phone--/._7�e_4 DZ------ Installation will serve: Residence B--Apartment House ❑ .0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J__ Number of bedrooms _P�.-. Number o baths J---- Lot size 11_. �____�5'Q+x - a Water Supply: Public system El Community system ❑ Private Depth to Water Table _947— Character 9:Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ ' Previous Application Made: Yes ❑ No New Construction: Yes ❑ No`O��Q TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sew r is available within 200 feet.) e Septic T nk: Distance from nearest welldDistan ___________. No. of compartmen _____,..__Size_______ Liquid � Capacity__?cm 40V Disposal/Field: Distance from nearest we��.-------Distance from foundation]_ ----------Distance to nearest line- ---____-- [u]� Number of lines_______________ Length of each line_________4-If --_____._.Width of trench_._.__ _r�� /� Type of filter materialf � Depth of filter materiaL______4¢_-.______-.Total length_"_____________ ___ Seepage Pit: Distance to nearest well------------_---------Distance from foundation__________________Distance to nearest lot line----------------- El Number of pits----------. Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation.-..----.---------- Lining material ____.------------------------_______ ❑ Size: Diameter---------------------------=----------Depth-----------------------------------------------------Liquid Capacity----------------------------gals. p Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____.__-__._-__________-_____..__..--.- ❑ Distance to nearest lot line------------------------------------------------------------------------ Remodeling and/or repairing Idescribe):------------------------------------------------------- ------------------------------------- --------------------•-------------------------------------------------------------------------------------••---------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and regulations of the San Joaquin Local Health District. ' ----------- --- --- ----- '- ---------------------------------------------=--------- ----------------- aatsr and/or Contractor (Signed)--------------- ( ) By:------------ ------- (Plot -----------------------------------------(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 APPLICATION ACCEPTED BY--------------------------- ----------------- -------------------------------- DATE --- REVIEWEDBY- •--------------------------------------------------- DATE-------------- -. ----�_�- - , 1 BUILDING PERMIT ISSUED---------------------------------U DATE----------------•-------------------------------------------- Alterato d/or recommendations:___ __l�-�-----------------"�--.-P_---�------"-.-.=./.R__. - ------ -----�--��---rte-- ----�a�r�r.�,�.s-�"•? �3 -- -- ------- --------�-------- -------------- --------------------------------- ------------------------- ------------------------------ FINAL INSPECTION x B-Y:. t Date ----------------------------------------------------------------- � --------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street X300 West Oak Street 132 Sycamore Street 814 North "C" Street t �. Stockton, California' e+,di, California Manteca, California Tracy, California