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t rt � APPLICATION FOR SANITATION PERMIT Permit No. ..- d. Z _ (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 &--k�JOBADDRESS AND LOCATIO ---------- ------- Owner's Name- t i • -_• ----- --- t------------- O -----•--- ------------------- --- ------------- ------------- -----._---- Phone---- -- --- Address............... ----------- -•---- --------------------- •---------•--••-------------•-------------•-•-----------•-•-------------- Contractor's Name ----• h. Phone = I --------•--------------- --- -------------------- -----•-- Installation will serve: Residence �Aparfinent House ❑ Commercial Trailer Court y { ❑ � ❑ Mated ❑ Other, Number of living units: �<munify � ber of bedrooms b i- Number of baths f_��'r Lot size _--L�►�-_. __ 1_ -------- --Water Supply: Public system system ❑ Private [:]' Depth to Water Table - ---___ ft. Characfer of soil to a depth of 3 feet: ' Sand ❑ Gravel [❑ Sandy Loam [-I—Clay Loam ❑ Clay ❑ Adobe. Hardpan ❑ Previous Application Made: Yes E] No l�New Construction: Yes �o El `�T' A' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . 4 a Septic Tank: Distance from nearest well rf ___Distance from foundationlP.----------Material-.--_-.----_---------_-_---- f No. of compartments ._. Size p ---- *� X Liquid depth- - Capacity p� � -•--4f--t............ Disposal Fieid: Distance from nearest well �Q-_--._Distance from foundati n-1.4----------- to nearest lot line.-r,>!_�_.._-_ I Number of lines----------- __-.._---.}- .- Length of each line-rf ; -F__ ___--_.Width of tr nch-. Type of filter material-_./ �" "'"__-_Depth of filter material--_��___-_______Total lengtf-_;;1_"� " Seepage Pit: Distance to nearest well-_-------------------Distance from foundation--------------------Distance to nearest lot line-_ ❑ Number of pits-------=--------------Lining material-----------------------Size: Diameter-----------------------Depth.------- ______-_-__-: �# ------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_----.---------.--_--_. - ---- --------- - Size: Diameter.-- ----- ----------- ---------------Depth-------------- ------------------...----------------Liquid Capacity-- g Privy: Distance from nearest weil-------------------------------------------------Distance from nearest building—__ ------------ ❑ Distance to nearest lot line----- Remodeling and/or repairing (describe)------------------------------------------------------------------------------------------------------------------- ---------------- ----------------------------------------- -------------- ----•---------.I---------•--------------------------------•-------------•------------- -----------------------------------------------------------------------------.-------------------------------------------------------------- --------------------•--------• ------------- I hereby certify,thaf 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 Local Health District. 4 (Signed)---------------------------------- --------------------------------------------------------------------- -------- ------ -- --------------------------- ---------------------------------------------{Owner and/or Contractor) By:-------•-------------------------------------- -----------------------------------------------------------------------------------(Title)-:.------------------------------------------------------------ (Plot plan. showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY-------------------- ---- DATE------ -- -------------------------- IEWED BY ----- --- --- --- DATE------ -r-•- ..... ` BUILDING PERMIT ISSUED--------------------- ....�1 -------------------•-------•---------•----------• ----- ----------- --------- DATE-----------•---------•----------------------- ----•-•---- -- Alterations and/o re ommen atio s: ..-- T ------ -- ------ ---------------------------•------••-------•------------------------• . '�- `- ------ ''�' '—------. 1----••-, ----------------------------------------------------------•-- . '� -- ----------•----------- FINAL INSPECTION BY:---- -..�i_- -._ . '"'e"r 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 Manteca, California Tracy, California Es-9 145446 ATw000 v