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APPLICATION FOS-.,jANITATION PERMIT Permit No. f 3 r (Complete in Duplicate) 3 / �' bate Issued Applica+ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND:LOCATION-----------44 !...... --,i,---„�----- ------------------- ------- ---------- - Owner's Name------• --•- - .. = Phone.# -------------------- Add( _ Address --------------- --------------------� �}�. - Contractor's Name------------- .. - Phone__ 3�3 J J f Installation will serve: Residence E3—"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Othe� d � Number of living units: ___r____ Number of bedroom' s __Z. Number of baths ___-t___ Lot size -14-.0-------)(./--7.1•_-_- Water Supply: Public system Community system❑ Private ❑ Depth to Water Table T'1 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑—Sandy Loam ❑ Clay Loam ❑ Cay [❑ Adobe [Hardpan ❑ Previous Application Made: Yes ❑ No P”New Construction:' Yes K?"No ❑ TYPE OFJNSTALLATION AND SPECIFICATIONS: ,; .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Dis#ante from nearest well- ._______...__Distance from foundation____________________Material-____._______.__.._..No. of compartments-- ------------ ------Size--------------------------------Li uid de th.------------- Ca acitq p p y-•--------------------- Disposal FijkK : Distance from nea�rest'weli_._.__ Distance from foundation--------------- to nearest lot line____.________---- �,,,�� Number of lines------------------------!__--------Length of each line---------------------------.-.Width of trench--------------------------------- Type of filter material--------------I------....Depth of filter material--------------.-------Total length-----•--------•-------------------------•- : Seepage Pit: Distance to nearest well _-_.__.__Distance froiY foundation_ _ 'stance to nearest lot iirp_-��____- rr -rs ' L� l�.umber of pits.----t---------------Lining matenaL_.--.----------_------Size: Dia ter__-- .�_3-�Deptn__.---�- ---------------_---- (I�, Cesspool: Distance from nearest well-----------------Distance from foundation...._...___--- .....Lining material__..__._.__-__.-----._______________ 1a1 ❑ Size: Diameter---------------------------- ---------Depth--------:-------------------------- ---------------Liquid Capacity --------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building-----------------------------------------, 3 ❑ Distance to nearest lot line------------- - ----------------------------j----------•------------------------------------------------------- Remodeling and/or repairing (describe):----------- ---------------------- ---- _----__-• - ----_.. ..............-----------------------------------»--------.------------------------------------------------------------------ V ------ ----• -•---------------__------------------------�_v_--_ .,______-_ f __________________________________________________________'_--_____.......__._---._._-_-_._--_________.____..-_._____-____----_-___.__________-.-_-___________-__________...--_-__-___-___--____________-_________--____-------- ....a 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 Local Health District. (Signed) = - - ------ ---- ------ --------- (Owner and/or Contractor) .-- BY: ----�-- .� :- '------ -----------------------------------•-- ---._(Title)--- . --� --'------------- -------------- -., (Plot plan, showing size a lot, location of system in relation to wells, buildings, etc., can be placed on rever�side). J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - ----------- DATE kyr Y REVIEWED BY------------ " ' �" DATE__ __ - -- BUILDING PERMIT ISSUED.--------------------------------------------------------'------------ -----" ------------- DATE---------- Alteratians and/or recomm f ns___ ______ _____ _ _ -- --_----__' __ -- ------ ----- - .-----��-� . :::: ------- ---------------------- ---- - - : ------------------------------------------------------- L�' FINAL INSPECTIONBY: -------------------------------------- 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 E9-9 145446 ATWOOD