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APPLICATION FOR SANITATION PERMIT Permit No. ._.l_. o.. (Complete in Duplicate) $� Date Issued Applica{ion 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. 4jJOB ADDRESS AND O,CATrIQN :'!?` G "f,, ---------/ODO---- ---1-------r- --- ,----- .. ': ------_- - ,c.., Owner's Name ---------•--- Phone..- • -------------- ---------------------------- Ah—AAV Address--------- ,. ---' y111- Contractor's Name--- ------ ----- •--------------------------------- ------------------------------------------------------------------ Phone----- •-------------------- Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mptel ] Other ❑L( Number of living units: --- Number of bedrooms - ._ Number 'baths l--��Lot _- size __-_--------------------- .( _-_---__--.-.-._ Water Supply: Public system ❑ Community system ❑ Private Depth t Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam C] Clay E] Adobe L] Hardpan ❑ Previous Application Made: Yes E] No ✓[f New,.Construction: Yes No ❑ rL TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sevier is _ available within 200 feetaDisance from nw - bstaSepticTank � nce from foundaTtion-------- -- ----,--,-�--Material ___-_--_------._-.---.-.----_..---_-----------. No. of compartments--------- -,_-._.z-Size-------------- Liquid d th _----------- -- _ Capacity ----Disposal' Field: Distance from nearest wel�_r. . i. istance from foundation_JO-�AD�s ante to nearest lot line---Z_L3_7t . ` [, Number of lines----------------------------------Length of each line-----------------------.------.Width of trench---------------------.------------- I Type of filter material-------------------------Depth of filter material-----------------------Total length---_--.-__--_-_.._-__._--_--_.___----_--- f Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.-------------. ❑ Number of pits-----f----------------Lining material-----------------------Size: Diameter.-----------------------Dept h--------------------------------- Cesspool- -------------------------------.Cesspool: Distance'from nearest well-----------------Distance from foundation--------------------Lining material-----------------,_-----------------. ❑ Size: Diameter- ----- -----------------------------Depth-------------------------------------------------_Liquid Capacity-----------------------....gals. Priv Distance from nearest well--------------------------------------- Distance from nearest building ❑ Distance to nearest lot line--- ---- -------- -- ------- ----------------------------------------- ------------------------------------------------- -------------------- Remodeling ant!/or repairing (describe):------ ------- - --- -----------------------------------------•-------------------------•----- -•--- ------- ---- -- ---------------------------------------------------•------------------.---------------------------------------------------------------------------------------- ------•------ --•- --...--••---- -----------------------------------------------------••----------------------- ------------------------•--------------------------------------------------•---- --------------------------•-------- -------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Signed).....1/- z-t/, --`"�'-'''-----a---<----- -------------------- --------=--------------------------------------------------------------Owner and/or Contractor) 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 APPLICATION ACCEPTED B i t l------------------------- DATE-(' REVIEWEDBY------------------------------ - - - - - ` I DATE---- ------•------------ ••-------•-----------•------- .� W- ---------- BUILDING PERMIT ISSUED = - DATE_ ------ Altera#ions and/or recommendations: - :` t °� ------------- 1 � -•---------------------•--------------------------------------- ----- . € ------------------------------------•----------•-------•------------ ----_-_•-------•-----------------------•--_--__--------------. ----------------"-_ _t-------------' --.-.------ -.--------------..---------..-----.-----.-_-----.._-__------_-----_------.---••__-•_---_•__----__-_-•- -------------------------------------------- - -----------------f------pm_-! -------------------------------------------------------------------------------------------------- -------------------- ' x------------------------------------------------------------------------------------------- FINALINSPECTION BY:. -------------------------------------------------------------- Date--------------------------------- ---------------------------------------•------ f SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWODO 12.54