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APPLICATION FOR SANITATION PERMIT Permit No. ' (Complete in Duplicate) _..7— -.Date issued` ii/_ __--- 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 TION_._-_----__ ." ._.x- .. ...... _ i -----------------.............. ,-------..«...----------------- Owner's Name- --- _-' ----- -----"- - ---- - -•---------------- ---- ----- -------------Phone... " Address--- ------------- t Contractor's Name...." _ - e --------- Phone. Installation will serve: Residence Apartment House ❑ Commercial / ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_C--- Number of bedrooms -- Number of baths _/---- Lot size..._Afot-OK/ QQ ' Water Supply: Public s stem r y Community system ❑ Private ❑ Depth to Water TablaJft,' r Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay EJ A-ddo _ Previous Application Made: Yes ❑ No K New Construction: Yes No E] T Hardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: I "r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well Distance from fqundation_ ,Q__�.._-_.Ma�eri No: of compartments- e Size. .. ..... -- .Liquid depth-.,�".--, ------Capacity aci Disposal Field: Distance from nearest well- _ _ P "" . �"._Distance from foundation-_-Q:_-'____-Distance to nearest lot fine-..--- _�___ Number of lines_...___----_._____ Length of each line - ----------Width of trench-------, --' Type of filter material..... ------- -- ----Depth of filter material....-AF"`I____Total length-.,"__•". f Sege Pit: Distance to nearest well ----_----------- ":..__Distance fro foun ation.-._ ".. -- e th -- Number of its-_ ----- Distance to nearest p _..__...__.Lining material._._Z. Size: Diameter.__- Cesspool: Distance from nearest well_"_______________Distance from foundation--,------------------� Lining material-------------------- ❑ Size: Diameter----------------------------- ----- --- -------- -------- -------Depth-------------- --------- ---- - --------Liquid Capacity------------------------- .gals. 1 rivy: Distance from nearest well--------------------------- Distance from nearest building ❑� Distance'to nearest lot line--- ----- g- ----- ..............................- W u LN t -- Remodeling and/or repairing (describe):- /� W -- --------------------- 3 __....__._."....-._."..._".............."._.__._•__..«"...-._.-.__-...-....-.-..._.-.._-----------..--_."- _. .................."---------._..-..-_. 1 .. ---------------------------------------•---------------•-----------------------------------' - ------------•-------------------------f--------- 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„ r sand reg ' ns of the San Joaquin Local Health District. (Signed)------ 1 ---- ------- ------------------------------------------------------------- BY� = t tact ---. -- , caner nd or Cont or) .- •- ------ ------------------------•----------------------------(Title 1 " (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be 'pla on rever40 se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... -- -------- --------------------- -------------------•--------------- DATE.-� REVIEWED 13Y ---------- ------ ----- . ---------•-------- ------------------------- ---------------- r ----- -- BUILDING PERMIT IS ____--._.."- _-- ------- ------ DATE-,- SUED Alterations and/or.recommendat ions:.._-_ ""---" ' � �DATE.. r . -J� �- �-� - --- ----- ---- -- ---- -----• '--------- -------- ----------------------- --------------------•------------------- ------«---------------- -----------------------------------------••-------------•------••------- ----------------------- ----------------- -------- ------- F • ' `` . FINAL °INSPI CTION BY:. --------------- 7/:r- . 1 . V Da fie. 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 Trey, California ES-9-2M Revised W-2100