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APPLICATION FOR SANITATION PERMIT Permit No. ._.. (� . (Complete in Duplicate) �l�X15 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. JOB ADDRESS AND OCATION----------- _ ------------ /1!t ------------------- -----------------------------= ` Owner's Name------ --A:.--gyp--------------- � N, ..Z�--------•------------------- --.- --.. Phone---------------------------•-------- Address...------ ��— �--------- e--------------------------------------------------------------------------------------------------------------- If Contractor's Name-------- •7 ;- -------- =�-xs' Phone Installation will serve: Residence QL_Apartment House ❑ Commercial ❑ Trailer Court' ❑ Motel ❑ Other ❑ Number of living units:___ Number of bedrooms .- _ Number of baths '�';___ Lot size -------4--0 1Q__fa--------------- -- Water Supply: Public system a Community system ❑ Private ❑ Depth to Water Table-,. . ft:' Character of soil to.a depth of 3 feet:: Sand ❑ Gravel❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No FNL New Construction: Yes Z_ No ❑ 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_;/_42ye Distance from foundation------%94--------Material__._,__�f ___ --------- No. of compartments_ _ ----- . l+r - -----Liquid Berx'`a th...... _ __ ----- Capacity------ I � - - �-- =:---Size____ __ Disposal Field: Distance from nearest well_.Lt,��LtD1stance from foundation___e4'S.___._._-Distance to nearest lot line-_ 7_0.... {� Number of lines____________ __ _..._-- Length of each line---------- -� -.-.Width.of trench___.____-.tZ____��__-__-_____ Type or filter material__�_�_ _:_�_ Depth of filter matErial__..._9. ._--'_:.Total length______ .-_--_____r'_ Qj,� �t .. P& Distance t�fearest lot line__.__)--._____ Seepage Pit: Distance to nearest Distance fpm fou�nd�t�ion___._. __......... Number of its.- _---- Linin material_- -' ----1%"�n Diameter---.-�--- _-Deptn_.__._. �------------- p g Cesspool: Distance from nearest well_________________Distance from foundation_.._--.-----------.Lining material-..___________._____' ------------- G . ❑ Size: Diameter-------------------------- .........=Depth-------------------------- ---:-----------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------------- ------------------------Distance from nearest building----------------------------------..------ ❑ Distance to nearest loft line-------- -•--------- --- - ------------------ ---------------------•-------------- -------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------- -----•--------..... --------------------- ---------••- ---------- -------------------------------•-------- -----•-----------------------------•---•-----•------------•-----------------------•--------------------- - - ---- •-----• ------- ---• .... I hereby certif 1 have prepared this application and-that the work will be done-in accordance with San Joaquin County ordinances, Sta aws, d rules and regulations of the San Joaquin Local Health District. / Contractor) (Signe -- ----- -------- -------------------------------------------- (Title)----- -(Ownand/or By. (Owner-- (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 DATE------------------------ --------------------------- REVIEWED BY-------------------------------- _ ----------------------- BUILDING PERMIT ISSUED---------------•--------------------- ---- DATE------------- - - --------------------------------------=------------------ - Alterations and/or recommendations:------------------------- ------ -- ------------- -----•-----------• -------•--•------------ ----------------- - ------ f--�/---------- ------------- -•-----------•---------. -------------------- •-------- •.... ----- —----•-------•---••------ . . , - . '�=A.........................................•-------------•-----------•------------- I i i ?..- - FINAL INSPECTION- BY:-------.. -,-1''4-��------------------------------- Date-- SAN JOAQUIN LOCAL HEALIH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5�9 145446 ATWCuD