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APPLICATION FOR SANITATION PERMIT Permit No. ..2.2 (Complete in Duplicate) Date Issued ----------------------- Applica+ion is hereby made to the San Joaquin Local Health District for a perm. ork herein described. I 06L 0 _�Oo construct and inst This application is made in compliance with County Ordinance No. 549. .97- 4' 1 �, � Z, JOB ADDRESS AND LOCATiQ�J.3... e ---------- _t�------------------e--- ------------ - Owner's Name Phone------------------------------- ---r ---------- ------------------------------------------------------------------------------------------------------------------ Address ----- -- ---- y Contractor's Name---------- Phone----------------------------------- ---------- 7------ ------------ - -------------------------------------------------- ----------------- ---------- -, Installation will serve: Residence------ --A Apartment-House-_E] Commer ial E] Trailer Court E] Motel E3 Other Ej Number of living units: _---f_ Number of bedrooms __Z Number of baths -1---- Lot size --------76--- Wafer Supply: Public system X Community system E] Private 0 Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] Gravel E] Sandy Loam E] Clay Loam El Clay El Adobe JW Hardpan El Previous Application Made: Yes 0 No 15K, New Construction: Yes No El TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest Distance froin foun�dption---- Mate 'al 1W_ I------------------------------------------------ No. of compartments........ Size&- ----Liquid-clepth---------!7j_---------Capacity----- X---TX- Disposal Field: Distance from nearest well_._..X'.b..Distance from foundation__ eg ______.Distance- to nearest ]of 11 e____ -------- Length of each line____________.0--- ,--Width of trench_____"2,o Number of lines-------------2........ Type of filter material_____ Depth of filter material--_--.--J- g_----.Total length---- i� ,e Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot I U---------------- F Number of pits----------------------Lining material----------- ---------- Size: Diameter-------•---------- ----Depth------------.-.---------___ Cesspool: epth---------------------------Cesspool: Distance from nearest well-------- --------Distance from foundation____________________Lining material__._____.._._____...__.____._______._ ❑- - --- Size: aterial----------------------------------- Size: ----------- ---------- -------------------------------Liquid Capacity Privy- Distance from nearest well-------------------------------------------------Distance from nearest building._________._________--__________.____.___-Distance to nearest lot line--- - - - --------------------- ---- ------- ----------------------- -------------------------------------------------------------------- Remodeling and/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------I------------------------ --------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------I—------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this applicalion.and that the work will be done in accordance with San Joaquin County ordinances, State laws nd rules and 4regq!l�ns a �a) Joaquin Local Health District. ........ ............. (Signed)---- -- ------------ ---- ------ ------ --- -------------- --- --------------------------------------------------(Owner and/or Contractor) - By:..-•----------- ------------------------------------------------------------------------------------ ---------------------------(Title)--:---------------------------------------- - - --------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------------- ---------- -- -------------- ---------------------- DATE _W1------ ------------- REVIEWEDBY--------------------------------- - - -- ------ ---- - ....... -------------- DATE BUILDING PERMIT ISSUED------------------------------ -- -- --- ----- ------------------- DATE--------- ------------ ------------------------------- Ai+era+ions and/or recommendations-------------/_ -4------------------------------------------------------------------------------------------------------------7-------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ ---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - --------------- --------------------------------------------------- --- ------ ----- -- ------------------------------------------------------------------------ ------------------------------------------------- FINAL INSPECTION BY:- _------ __-------------- Date--------------77�--- ---------- ........ 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 E F-9-2 m 145446 ATWDDD 12-4 101