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APPLICATION FOR SANITATION PERMIT Permit No... L_7_4____-- (Complete in Duplicate) • Date Issued Application is hereby made to the San Joaquin Locai Health District for a permit to construct and install the work herein described. This application is made in compliance with•County Ordinance No. 544. u , JOB ADDRESS AND LOCATION_-._________ _ "" ---------- --- - --- Owner's Nams---------------------•- ' - f --------------------------------- Phone-------------------- ---- - ---- -- Address " Contractor's Name_________ ___________ q ---- -- ------------------------------------ ------ Phone - --------------------------------------------------- Installation will serve: Residence artment House ❑ .Commercial ❑ Trailer Court ❑ Motel r/ � E] Other r Number of living units: V--- Number of bedrooms _�---- Number of baths --/-- Lot size ____ .___ __ Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ G vel-E] Sandy Loam p Clay Loam E] Clay,E] Adobe ardpan ❑ Previous Application Made: Yes E] No ew Construction: YesA+-AidoE1 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic ank: Distance from nearest well__ �-yg,. stance fro foun tion_ r{ Mal- ----- -- --- .......... No. of compartments---------- •--Size____[ - --- � _Liquid depth---------�-----------Capacity---� --- v ,,,,��// Disposal Field: Distance from nearest well___A istance from foundation__-1- - ------Distance to nearest lot line__ i NZV Number of lines___________________________________Length of each line------ Width of trench_________ L-( ---- sem--- ----------------- Type of filter material--7c7_e__ Depth of filter material___-�_ --_____ ---Total length Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------..Distance to nearest lot Ii ❑ 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 Q ----------------------------•----------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------- _----- •---------------- ----------------•----•-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i ----------- (Signed)--- -- --_t--- •_-'-- _---- _ ------------------(Owner and/or Contractor) By-------------- -- ------------------------------------------- -- - - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). -------------------------------- 9 p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ ------ ---- --------------------- - DATE------- REVIEWED BY f BUILDINGPERMIT ISSUED_ -------------------------------------------------=------ --------=----------------- DATE-------------- -------------------------------------------- _________ r DATE ------------------------------------ ------ Alterations and/or recommendations:_ ---p--- ` - ------ -- :------------=-------- ---------- - ------------------ ----- e------� --------&W.-._- 1 ------ ---------- vT ► 1 ? - 'W------ - -rte-----` ,r1 ----------- &t -Roa,------ .-- k------------- --- - ----- -------------------------------- - FINAL INSPECTION -BY:-------------- Y k , ' Date----------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 SoutK'American Street 300 West Oak Street o. 132 camore 5tre 814 North C" Street Stockton, California Lodi, California Manteca, California Treey, California r �ie. ref „- ES-9-21v1 8-51 Revised W-2100