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APPLICATION FOR SANITATION PERMIT Permit No. _..._1.. D Z ♦� (Complete in Duplicate) 2 a 17 Date Issued !_�.__---/__, /Installation ereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. is made in compliance with County Ordinance No'-S49.AND LOCATIO - °� '- '�- L •--------------------------- _.,u_�-C1= 1--•----- -•-f•----� --------------------------------------:------------------------------------ -- Phone.--------•-----------•----- -------- ..ame------ ---------------------- ----- -•-- •----------- -----------------------------------------------------------------. Phone----------•-------------- --serve:- Residence [ pe tment House ❑Commercial ❑ Trailer Court ❑ lylotel ❑ Other ❑ Number of living units: Number of bedrooms .____. Number of baths .! (� Lot size ----------------- �+ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam F] Clay Loam ❑ Clay E] Adobe�ardpan E]Previous Application Made:. Yes E] No �ew Construction: Yes ErNo ❑ ; TYPE OF INSTALLATION AND SPECIFICATIONS: _ (No septic tank or cesspool permitted if public sewer r is available within 200 feet.) �.. ,,. # ♦ ;� Septic Ta Distance from nearest well__: dDistanc from foundationr/�J_____________Mat rias____._-______________.___.___-._ _.-______.._. ; No. of compartments-_ _.... .........Size----- Liquid depth--------------------------Capacity----f'/�/ n Disposal field: Distance from nearest w,-Il- Distance from foundation .1_�'/_____.Distance to nearest lot line ----`r/.____. Number of lines_____________ ___ Length of each line____ _____ Width of trench._. _'' ♦i .,, Type or filter material____��.__...___� Depth of filter material____/.'�?..._._.___Total length___ .�J____________________________ Seepage �t: Distance to nearest well__-��____._Distance from f ndation__..f. .--_. ..D3n�fto nearest lot line------�_-_.-___ Number of pits.-------------------Lining tnaterial---_ ---Size: Diameter__.------------------Depth.--- _S� --------------- Cesspool: ------------- ' Cess ool: Distance from nearest weft_____ _.____ Distance from foundation____ ______________..Lining material___.___....__._. __.___-_______, p� p MMM ❑ 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)______________________ -------------- r ____________________________________________________________________________________ 'F __________________._____.____-...-.----__._______...____________________-________________.._._.-.-.-..-_.-.____.______________________________-__..--__..___-__.._.________________._______--____._______-if�_--_-_--_-._----__ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatio, s-bf the San Joaquin Local Health District. a �Si ned 9 )---- --��-- ----� ---------- - - -------- ---�--'��_„�.---- --------------------------------------------------------------- -------(owner and/or Contractor) By:-----------------`-------------------------------------------- ------------------------------------------------- --•---•------------(Title)------------------------------------------ - -- ---------------- (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 - a APPLICATION ACCEPTED BY--------------- ------- - ----- ---------------------------------------------------- - D'ATE --- s7 REVIEWEDBY--------- ---------------------- - -------------------------------------------------------- DATE----(.. . ..-- � � BUILDING PERMIT ISSUED------------------- -- -- --- -- ------------------------------------ DAT Alterations and/or_recomm ndati ns' --- -------- - - ---- ------------------------------------ -------- ____________________---- _------------------------------------------------_---------------------------- ___ J i. _ `..-01 _ --------------------- ------ ---------- • ---------------------------------------------------•---- ---- --:----- lit -------------- - FINAL INSPECTfON BY-- - -- - - ----------•-------------------- -------------- Date--------------------------------- ---- --------------------------- 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 4 �� E5-9 Ya5nc6 aTwoOo