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APPLICATION FOR SANITATION PERMIT Permit No. ...... (Complete in Duplicate) / W5-4 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. J08 ADDRESS AND LO AT �y�3-------0*----------------------------- ------ Owner's Name- ----- '.. •------... c --- ---------- Phone --------------------------------------------------------------- Address ---•- - ----- ------------------ ------------------ / Contractor's Name - -------------------------------------------V---------------- Phone_ =._ G� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court•,❑ Motel ❑ Other Number of living units: ___ Number of bedrooms _9___ Number of'baths �- Lot size �p 4 --------------- Water Supply: Public system ®K-c-ommunity system ❑ Private ❑ Depth .to Water Table `�� ft. { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑', Clay Loam ❑ . Clay ❑ Adobe �Eardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ❑ 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-)'A Distance from foundation__-A4.. .Material n_____'_� Q�_---. No. of compartments--_--- -- ---------- 56 - 6_ •f---Liquid depth----- ----------------Capacity------V--__-_----- ' ,el4�______...Ujsfyce to nearest lot line---- .________ Disposal Field: Distance from nearest weft ___. _ _Distance from faundatian__ __ �� Number of lines_______ _ ________ y ' ---- Length of each line__ s-_l.TS�YS_-- idth of trench.---- --- i-------- ------ Type of filter materi I- (--- �_ .__.Depth of filter material._._ -S __,_,;;_._Total length____3. 17-______________________ 1 Seepage Distance #o nearest well_�Zd�--____Distance from foundation--�.'_- '�� .� ..__.--Des#a5� e to nearest lot Zine_________________ Number of pits.2...y-.._..______.Lining material Ad': A''.Size: Diameter__._ _ _.,_ ,_Depth........ ---------------- Cesspool- _-________ Cesspool: Distance from nearest well-----------------Distance from foundation-------.--------------Lining material-------------------._________________- ❑ Size: Diameter---------------------------------------.Depth---------------------------- --- -------Liquid Capacity----------------------------gals. (`�t Privy: Distance from nearest w --------------------------- ..._Distance from nearest building ❑ Distance to nearest lot line-------- -------------------- •-------------------- --------------•-------------------- -- 4 Remodeling and/or repairing (describe)---------- -------------------- -----------•-•--•----•--------------------------------------------------------------------.....................................---------•------•-------------------------------------------------•----------------•----- i I hereby certify:fhat I have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, a laws, and rules and regulations of the San Joaquin Local Health District. y 14 ( ner and/or Contractor) (Signed) - � --------- -- - By:.................... ------- exi .- ------ --(Title) (Plot plan, showing size of lot, location of system in )=tion to wells, buildings, etc.,.can be placed on reverse side). -FOR DEPARTMENT USE.ONLY " APPLICATION ACCEPTED BY------------------------------ ____ DATE______ REVIEWED BY-------------------------------------------- ----------- - - DATE-----------•-----`--•--•-------------•---------------------- BUILDING PERMITISSUED-------------------------------------- -- --- DATE------------____-- _- Alterations and/or recommendations:_:------------.__- -------------------- -------- I- � ------------------------- ----------- --------------- ---- -----------I--------------------------------------------------------------- -- ----- FI NA L-I N S PECTION, BY:--- - J s------------------- --------- Date. � �:.-�:-��'.`..�..�. - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street e14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 A7WODD