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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 fora permit to construct and install the work herein described. This application is made in compliance with County Orr`dinanceelo. 549. JOB ADDRESS AND LOCATION__.__._.. _ C ----- -----------•-------• -- --••--------------------------------- 1<_ --- --- - - - -----•------------•--- Owner's Name---=------------•-- y�,!„rr�--W� ' - - - • -- -----�---------------•---------------- ------- ---- ----- ---=----- Phone. Address--------------••--------- •- _. i --------------------------•------------------- -------------------•-------•--------------- Contractor's Name_______________________ -------------------------- ---•---- -------------•- Phone .. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � Number of living units: -- ----- Number of bedrooms le.. Number of baths -j----- Lot size __-- Water Supply: Public system �< Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of;3 feet:, Sand ❑ Gravel ❑ Sandy Loam ❑ Gay Loam ❑ Clay ❑ AdobeHardpan ❑� Previous Application Made: Yes ❑•�No�9( New Construction: YeNo s ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: O (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank,. Distance from nearest well _.______.__.__Distance from foundation_______________ Material = ❑J.44 Na. of compartments-- ------ -- ----------Size--------------------------------Liquid depth. ----------------------•------------------ ------------------------------Capacity---------- ------- Disposale d: Distance from nearest well_________________Distance from foundation_____ .�---.-_Distance to nearest lot fine___-�_ .__ _ Width o Number of lines------I------------------------ --Length of each line------g -�--- --.-. f trench_____ Type of filter material-- •� _ Depth of filter material----1.�-- --------..Total length--_1110 1----------------------------- Seepage Pit: Distance to nearest well----------------------Distance-from foundation-------------------Distance to nearest lot line__________._.____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----- --_-- Cesspool: Distance from nearest wellDepth------ ------------------ Size: Diameter-------- ----------------- __Distance from foundation___________________ Lining material_._____..____..___._--.___ ❑ - -----------.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 I have prepared-Ais 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. ��pp 7 4 (Signed)-------� � ------ -----------F •----- �Y ------(Ow her and/or Contractor] -------- •----------------------------------------------- --- Title j ______ (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 ! REVIEWED BY DATE Alterations and/or recommendations- e ----- DATES--)17 :,Y&_ BUILDING PERMIT ISSUED----------"-__"--------------"- _- --.----------------------- ---------------- DATE------------ ------- - ------------------- ----------------------------------- ----------- ----- ---- --------------------------- FINAL INSPECTION Date_._-f.-----• . _ . -. 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 ES--9-2M�'� 4544fi�ATW ppp 1T-5q �- T --�-�-