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4 . #�'� APPLICATION FOR SANITATION PERMI Permit No. ___ ..�0-v t1' (Complete in Duplicate) ' f Date Issued . C ! � p?rc Loca4 Health District fora ermit to construct and install the work herein described. ion is hereby made to the San Joaquin P This application is made in compliance with County Qrdinance No. 549. �� i JOB ADDRESS AND LOCATIO ________________ - - a 0-r------------ ---- ------------------ Phone__ ��---_ -------- Owner s Name--------------------•�--��-----------•�� . " -------- ---------------------------- Address-------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name------------II-- - 4.!_YI•` ----- - - ----------------------------------------------------- Phone------------------------------------ i ----:----------------------------- Installation will serve: ResilI`�Jence 53 Apartment }-louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .i�-__ Number of bedrooms -_-/_ Number of baths"' -- Lot size -----_s d X__ --------- Ile - Water Supply: Public Sys 11P Community system ❑ Private ❑ Depth to Water Table -------- ft. (—a Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Maddi Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: a� (No septic tank or cb ' sspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---_--.____----_Distance from foundation--------_----___-_-Material____________________________________________ •_. ❑ No. of� ompartments--------------------------Size--------•-----------------------Liquid depth--------------------------Capacity---------------•------- Disposal Field: Distance from nearest well------------ --Distance from foundation--------------------Distance to nearest lot line_----_--_-___--_.. ❑ Numbeqkr of lines-------------------------- --------Length of each line Width of trench ------_----- --- Type of filter material-------------------------Depth of filter material-----------------------Total length---------------------------.-------------- t Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------.Distance-to nearest lot line--------.-------- ❑ Numb�� of pits----------------------Lining m --------------------- Size: Diameter--- -------------------- Deft II _Cesspoc�4: a F = Distance from,nearest well= :Di`sance from foundation "'Lining aterial '"" w ar 11, . - f 1 =rm �- J -- Size: aLameter �C -sd- ---------Depth ------->----- - •------- ----- Liquid Capacity'_'_____,75 gals. 41 p Privy: Distan 4e from nearest well-_-_-.---__.--.--_-_---------------------------Distance from nearest building------------------------------------------ ❑ Distane to nearest lot line------------------------ -- - ---------------------•------------ ---------•-------------- ----------------------- Remodeling and/or, repairing (describe)=-------------------------- ------------•----------•---------------------•------------•-----------------------_-_------------ ----•-•----------------------•---------------•------- 1. - ------------ - I hereby certify the+ I have prepared ts his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, anti rules regulations of the San Joaquin Local Health District. r -------------------------------------------------------------------- ----------------------------------(Owner and/or Contractor) t (Signed}---�-__-_-�----�-- ---dd-hh- ------------------ - (Title)- "------. By:---------------------------------------•----------- -- --- (Plot plan, showing size oflGlot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i 9 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- - -- -- - -------------------------------------------------------------------- DATE -------�/+-' �--�'--- - --j/-�&F/-�a----�==---' REVIEWEDBY--------------------•---------------- ----- ---------------------- -------------------------- DATE------------------------------`- --------------------------- BUILDINGPERMIT ISSU b--------------------------------------------------------------- -------------------------------------- DATE----------------------------------------------------------.- Alterations and/or recommendations-------------------------------------------------------------------------------------------------------- ------------------------------------------------------- s. 1111 -------------------------------------- --- ------------------------------------------------------------- ---------------------------------------------------------------- ------------------------------------------------- ------------------------------------------- ------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------- 1 ----------------------------------------------- ----------------------------------- ------------------------------------------ �p-------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------- r� �S FINAL INSPECTION BY.. --------------------------- Dater/ ---J - ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sfreet 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California H Lodi, California Manteca, California Tracy, California E5-9-2M 8-51 Revised WI2100 %'� a P '�