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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) . 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. S49. JOB ADDRESS AND I OCATI ____________ ___L ,d► ,.�e,--- --- �Jjys /� .�� c. m�, '„ Owner's Name------ - ------ Phone-----------•-----x-- s� --- Address---------- ••--- .. ` ... _ Contractor's Name------ --------------------- Phone----------------------------------- Installation -- -- ------------ Installation will serve: Residence F-Apartment House ❑ Commercial ❑.- Trailer Court ❑ Motel ❑ Other ❑ Number of IiGing units:/-----_ Number of bedrooms _,�-Number of baths f_____ Lot size ----1__41- _ -� -----------------:------------------ Water Supply: Public system ❑ Community system ❑ Private j?j--flepth to Water Table,5;5�d4,. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ja Hardpan ❑ Previous Application Made: Yes ❑ No E4_ New Construction: Yes R 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___�s.___Distance from foundation-_,/e-_____.____.Ma'teriai_____ '- -1 4�• -_-------. P -------- Size-� ..... q P ----- P y-- No, of compartment -_--- __Liquid de th__. _. _ .Ca acct Disposal Field: Distance from nearest welf-_<6_457.±Distance from foundation___,___-Distance to nearest lot line____ Number of lines_______ _______ Length of each line________lg_Cj________'�.,,Widfh of trench...._-- _- `l : . y`---------------- Type OT filter material---Zgx---f,- _Depth of filter material______ ____ ____.Total length------ f Seepage-Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--__..___________ ❑ Number of pits----------------------Lining material----------------------_Size: Diameter-----------------------Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation______ __ _______Lining material_.____-__..__..____.________.______- ❑ size: Diameter `Depth-.-.-- - ---------------- ---------Liquid Capacity--------------------------._gals. Privy: Distance from nearest Well--------------------------------------------------Distance from nearest.building---------------------------------------_-, ❑ Distance to nearest lot line--"-------------------------- - � Remodeling and/or repairing(describe)------------------- ------ -_ • .-_-:-._`_-'_ --•---•---------------------------------------------------•------------------=------------=--- ------•---------------------•---------------------- ----- ----------------------•------------------------------------••---------------------------------------------------------•-••----------------•------_-- --------•-------•----•----------------------------------------------- --------------------------- ------- -----------------------•-----------------------------------------------•---=---------•------------------------•-------------------------- ---------------- ------ I hereby certify that]-have prepared this application and that the work will-6e done in accordance with San Joaquin-County ordinances, Stat and rules and regulations of the San Joaquin Local Health District. _ (SignedF......- - -- -------- -- --- -------� (O.(Owner and/or Contractor) .. ----------(Title)------- T= ---------------------------- -- --- \ (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 V.,w_ REVIEWED BY ------------- DATE---4 ..................................................... BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----7ii; Alterations and/or recommendations:-,--------------x------ ---------------------------- r,_ 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 E$-9 145446 ATWDOD