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,1qs� ✓ N APPLICATION FOR SANITATION PERMIT Permit No. �....... k` (Complete in Duplicate) �, Date Issued Applica{ion is hereby made to the San Joaquin Local Health District for a permi+.to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI f/ - -----;----- --------- `.. ---------------------------------------------------------- •------- ------ .-n Owner's Name- ---• -- -- --•---- - -- --------- -- ------- ----------------------------------- Phone------------------------ - Address--------- -- -- ----------- .rte---------ISE Name-----...: ------------•----== - --------------- Phone l? �eD_. -4 Installa+ion will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:{.---- Number of bedrooms -��Number of baths __ Lot size -----/a0__�---1__Z'S.�---------- Water Supply: Public system V--Community system E] Private ❑ Depth to Wafter Table 6'6-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pg.,Hardpan ❑ Previous Application Made: Yes ❑ No W -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: �_.PjAance from nearest well------------------Distance from foundation--------------------Material------------------------------_------------------ -:=Yccompartments--------------------------Size--------------------------------Liquid ompartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity----------------------- CC// 3 Disposal Field: ante from nearest well-................Distance from foundation-. _----------------Distance to nearest lot line----------------- r r of lines----------•- ------- ----------- -Length of each line------------------------------Width of french----------------------------------- Ty e of filter material-------------------------Depth of filter material------.----------------Total length---------------.-------------------------- Seepage -----.-__--_-------_---_. See a e Pit: Distance nearest well_. .-. stance from founda.ion___ p g /� �-i ��/ .�__ ---- t9 nearest loft lin��_� ' _ Number of pits..--_�-------------Lining material_LG!3 "�i2zlg Diameter.___ B�._3..___Depth____-:�4� ------------- Cesspool: Distance from nearest well----------------'Distance from foundation--------------______Lining material---------.-------_-_-----.-.___------. ❑ Size: Diameter--------------------------- ----------Depth------------ ----------- =- -----:--Liquid Capacity----------------------------gals. 0 Privy: Distance from nearest well-----------...:------,_._._------------_.------- -.-Distance from nearest building-.--------._-_______----_-__----.--_--.- ❑ Distance to nearest lot line---------------------------1---------------- - -" Remodeling and/or repairing (describe):-------------------------------------- ----- -------.....;-....----•--.....------------------------------------.----•-•------•--------------•--------- --------------------------------------------------------------=-------------------------------•=---------------------------------------------------------=---------------------------------------------- --------- ------ .. I hereby certif + I have prepared this application and that the work will be done in accordance with San Joaquin.Count� ordinances, Sta Maws nd rules and regulations of the San Joaquin Local Health District. {Signed)-••-- ------- - / `- ----- ---- -------------------•------------------- ---------�-(Owynneer and/or Contractor) --------------------------- (Plot plan, s owing 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-----I'----------------------- ----------- ------------- REVIEWED BY ---- ----- DAT --------------------------------------•---- BUILDING PERMIT ISSUED------------------------------------- - 5 DATE---- &, ---------------------------------- Alterations and/or recommendations-------------------------- --------- .---.----I—— -------S__ ------------------------ --- _ f ------------ ----- _ ---- -31 - ----- .;:fir- --r're' -' -----------•-- ------------- --- -----------------•-------------------------- FINAL INSPECTION BY:. �1 Date. C -- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycaniore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California l Es--9 ,49446.nvwnno