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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicatel / Date Issuedr-- Applica-lion 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�co�pl�hcewith County Ordinance No. 549. OB ADDRESS AND � CLrOvC�/Aa�Tf_O.._N � _ - -/. ---------- �.�- - _ lt: . - Owner's Name--- P� • . - ------------------ Phone---f ----- ----•---Address. %K2 -------- - •------ ® ame_. L------------------------------- ------ Phone.------... Contractor's Installation will serve: Residence Apartment House ❑ Commercial „ [I Trailer Court ❑ Motel El ❑ Number of living units: --a---- Number of bedrooms __9.._ Number of baths Wafer Supply: Public system ❑'Community system ❑ Private [Z. Depth to Water Table'�b-_ ft I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ® Clay Loam ❑ Clay [I Adobe El Hardpan E]Previous Application Made: Yes E] No ® New Construction: Yes Fj No ❑ A �` TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tanVcr cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest awelt-____S° Distance from foundation___:---_ E. -- ----Material--- v No. of compartments_----- -------------Size----9•y- `i''�-`'---------- - Liquid depth------�------.--------CapacitY---�--�--4-`� ► ---U Disposal Field: Distance from nearest well__--�_fl_-_-- -Distance from foundation__--!___5_-------Distance to nearest lot Iine.__ -____-__-� ® Number of lines _1___ Length of each line--------I--O-o-------------Width of french.... ff'!_-__ Type of filter maferial__�_y--------------Depth of filter material- -/-*'."--:--------Total length---./_Q-a-' -----•---------- Seepage Pit: Distance to nearest well-_--------�_..._--___Distance from foundation___________________,Distance to nearest lot line__-_-.________- �. ❑ Number of pits-- ----- -------------Lining material-----------------------Size: Diameter----------- -----.----Depth --------- ------Cesspool: I. ------sfromnearest wel________________Distance ' from foundation.-.:.-_....___.__ Lining material__ -------- [] Size: Diameter ------ - ------------------- ----Depth-------------------•--- -- - -- ) y - Liquid Capacity_-=---.-----•---------------gal NL/ Privy: Distance from nearest well'-, .._------_------------------ ---------------Distance from nearest building - -•---- ❑ Distance to nearest lot iine_..__--------�' � ---�--- ------ - -- ----- ____ Remodeling«and/or repairing (describe):-_ y ` --- •------. ------•------•--------•----------------- -----------•---•-------• --•---------•--------•- -------------------------------•-----•-----------•-----------------••-----•--------••---•-•--•--------- ---------------------------------_---------------- ----------------------------------------------------•-••-----------------------------------•-----------------------------•----------•-----------------------, I hereby certify that I have prepared Phis application and that the work will be done in accordance with San Joaquin Coun ordirta rr nces, State laws, and rule -and'regulations of the San Joaquin Local Health District. ,�/ (Signed) vv- „"�- =-.Y C�f`:c��y � ------------------------(Owner and/or Contractor)' ' By:----------------------------------------------i - ------------------------------ -- ---- = -- ----- Tale ( �, (Plot plan,.showing size of lot, location of system in relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ � -------- ---_ DATE__.fl_f i REVIEWED BY `------•------------- ------------ --------- ......................---•----------------------------------------- -----.----- ----------------------- - DATE------ --•------•------------ BUILDING PERMIT ISSUED------------------- •- - - ------------ ----------------------------- --- --------------- DATE.-------------•- -------•- A terations and/or recommendations:-------------------------- ------------- ------------ ------•----- - FINAL INSPECTION BY:== ----•-- ............. 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 EF-s 145446•ATW09P