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wv 1 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate)�Cm p p ) Date Issued ----Y4 Applica+ion is hereby made to the San Joaquin Local Health District for a,permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. S49. Ar JOB ADDRESS A LO•-ATIO __;-rte- - ----t--¢un ------------- ------ ----•-------..----------- ------------------------------------------------------------------------------------- Owner's ----------- Phone--------------- 1 J Address------ - . _...---••--------------------------•----------------------------------------------•--------------------------•-------•---------------- Phone----------------------------------- Contractor's Name_ f Installation will serve: Residence Q�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑/ Other ❑ Number of living units: _ Number of bedrooms _Z.- Number of baths --1.-__ Lot size -.X-�-�-G!�------.--•---------•--•---------•- 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 ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ � Previous Application Made: Yes ❑ No E/ New Construction: Yes M No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: bmi (No septic tank or cesspool permitted if public sewer is available within 200 feet . Septic�Tank: Distance from nearest wall-- S-------Distan5e from fo rlclation_f_ ____�____._Materialju!�'_____---________ ________-- ------ 4 hfo. of compartments---------- -- -------•----size _ _ -------Liquid depth-.--------' ------------Capacity---�-Qj-_------ ® Y Disposal Field: Distance from nearest welL�O_.------Distance from found tion_�._ .e.._____- Distance to nearest lot,1i�+e 1-5 0-Width of trench------ , ,---------------- 0-30-10d Number oT lines--------.- 3- -x- ------f---Length of each line--- - --- --- ----- ----- Type of filter materia 1-+�"�'-�-Depth of filter material--_...�--________Total length--------- -Z.o----_______________ Seepage Pit: Distance to nearest well---------------______Distance from -------- foundation------------- to nearest lot line------ Seepage Number of pits--------____----------Lining material-----------------------Size: Diameter------------------ Depth_______...____________.________ Cesspool: Distance from nearest well-----------------Distance from foundation------------<------.Lining material-------..---__.._____________._____- \ ❑ Size: Dia meter-------------------------- ------ ----Depth----------------------•--------------------------Liquid Capacity----------------------------gals. \4) 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.prepareci this.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. (Signed •4�__� -------------------- ------------------ ---------------- -•-------------------(Owner and/or Contractor) --- ------ - --- ----------------------------- - By------------ - � i ----- ----- -- ----------------------------------------------(Title)----------------------------------------------------------- --- --- -- ---- --- •------- -- - (Plot plan, showing size of lot.kloocation of system in relation to wells, buildings, etc., can be placed on reverse side). + FOR DEPARTMENT USE ONLY I s --------------------------- DATE-APPLICATION ACCEPTED BY_- ------- -------------------------------------- REVIEWED BY----------------------- -------::---- -------z------------------------------ ------------.---:--------------- DATE__ -------------------------------------------------- - t BUILDINGPERMIT ISSUED----------------------------------- --------------------------------------------------------------- -- DATE..--.-..4y.,------------ ---------------------------- Alterations and/or recommendations:------------- ---------- ---------------------------------------------.._....--------------------••---- •--••------------- •----------- ------------------------------------------------------------ ----- -------------------------------------------•----------•--- ----- . - --- -- ----------------------------------------------------------- --------------------------- ----------------------- - --- I Date. ----------------- BY:_FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California E5-9-21`1 145446 ATW000 12-54