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K a lie, APPLICATION FOR SANITATION PERMIT _. Permitr.Nci ___�:� (Complete in Duplicate)?! r_ + Date Issued _-_-________-_I Application 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. Q` ¢" JOB ADDRESS AND LOCATION____ La t _ 1 °---------------------=-------=--------------------------------------- '� ---------=---------=--------- l Phone-5"7 _k ---- Owner's Name--------------------�---- --- - Address- = 7t _ +',f --------------------------- ---------------------------------•---------- ,J iContractor's Name----�-!o -------------------------------- - --------------------•---------------- Phone------------------------ •-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Mofel ❑ the ❑ f/ �7 Number of living units: ________ -umber of bedrooms -------- Number of baths Lot size.t___ `_✓_------- _f_ ___ ___________________________. �. Water Supply: Public system 4 Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam El Clay ❑ Adobe Hardpan ) Previous Application Made: Yes F] No [V� New Construction: Yes W 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_________________Distance from foundation--------------------Material---------------------------_____________________- . ❑4/� No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Di�fance_from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line______-________:_ ❑ c 'Number of lines-----------------------------------Length of each line------------------------------Width of treFich----------------------------------- G� Type of filter material--------------------- ---Depth of filter material----------------- "``-Total length------------------------------------------# Seepage Pit: Distance to nearest well______________ ______Distance from foundation--------------------Distance to nearest lot line__-_________---_- } ❑ Number of pits----------------------Lining material_----------------------Size: Diameter------------------------Dept h---------------------------------� r Cesspool: Distarce from nearest well-----------------Distance from foundation--------------------Lining material________-___----_____-_ ❑ Size: Diameter--------------------------- -----Depth-------------------------`---------- ----------------Liquid Capacity----------------------------gals. "- Privy: Distance from nearest well____________________________,_____---__------__Distance from'.nearesf building______-__--____________________-__-___-. ❑ Distance to nearest lot line------------------------------------------------- Remodeling and/or repairing (describe):------------------I---------------;----------------------------------------- -------------------------•--•---------------------- ---------- j -------------------------------------•-------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------'------------------------------------------------------------------------------------------------------------------------ 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, and rules and regulations of the San Joaquin Local Health District. (Signed)----X11' -A-.-_'`'-- -----------------------------------------------------------------------------------------------=---(Owner and/or Contractor) By:---------------------------------------------------------------------------------------------------------------------------------(Title) - (Plot pian, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR'DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY-- "- - - -- DATE-- --------------------------------------------------- ---------- -----=-- - ---- --------------------=- - REVIEWED BY-------•---------------------- ---- DATE----- ----- ----------------------- -------- --------------------------------------- BUILDINGPERMIT ISSUED------------------- ------------------------------------------------------------------------ DATE----- ------ I Alt�xa ns and/ r reFommenda'fions' s , ---- - -- ______________�_______.____--___-____________ -- .___________________________-[------_--__----�---------------------------------------------------------_-_______________.____�_-______ k _______ ` _________ .__- - l---r_ 4":Y�-----�__ _ .1�.j ____________________________ == s c� `f 5 - _ i �. 2L,..t FINAL INSPECTION BY: ------------------------ ------------- Date---- ��' r'��` ----------------------------------------------- SAN -------------------------"------------------SAN JOAQUIN LOCAL HEALTH DISTRICT a 130 South American Street 300 Wast Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 21x1-'8-51 Revised W-2100 c -