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Y APPLICATION FOR SANITATION PERMIT Permit No. -�-- APP / {Complete in Duplicate] Date Issued ./-7¢-- gAan Joaquin Locale Health District for a permit to construct and install the work herein described. Application is hereby made to t e S q This application is made in compliance with County Ordinance No. 549. -3 --------- JOB ADDRESS AND LOCATION..__ ------ --- Owner's Name----------------------------------------- ---- - =t------- Address ------ -- - ---------- --------- --------------- Phone-------------------------------•---- Address---------------••---------•--------------- Contractor's Name_______________________ - `1 ,, ", 'hone-. .=Cl�-------•------------ Installation will serve: Residence _ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑/ Other ❑ Number of baths Lot size ------ --- /�-------,i ---------------------- Number of living units: �__ bar of bedrooms __ ___ �-•- - Water Supply: Public system Community system Private ❑ Depth to Water Tabl - --� ft. Loam Clay Loam Clay ❑ Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loay ❑ �/` w Construction: Yes ❑Previous Application Made: Yes ❑ No �] Ne { TYPE OF INSTALLATION AND SPECIFICATIONS: _d 1 (No septic tank or cesspool permitted if pubic Ar is available within 200 feet.)! l 1-Q Mat r I -- ----- f f Septic tarsi a Distance from nearest well Distant from foundation__ _-Ca aci . 7- - Liquid de th - p tY t� 'r [1� No. of compartments--- -- 1ze__ --- - q ! 1 Disposal 1 d: Distance from nearestwell _ from foundation-A)------- Distance to nearest lotline_ ------------ .-Distance Number of lines-_ _ Len th of each line____ __ Q Wicth,of trench___________________________ Type of filter material s_ - Depth of filter mat00 erial-_.._-/.-Z. — Total Meng#h_____ ___lS-------------------- C Seepage Distance to Weat well' `/6 Distance from f ndation_-_ ----------Distance to nearest lot line_-__V---..---- P• /.y Number of pits-re ------- --Lining material �--Size: Dia meter--- _r-.........Depth... _----------------- Cesspool: Distance from nearest well--z\ . --__ afrom foundation-_-----_-__.__---_.Lining material_-----------------_.- -__--_--_-------- � _ _ : _ - -Liquid Capacity gals. ---------------- F------------,-_-.Depth ❑ Size: Diameter _ Privy: Distance from nearest well--------------------------------------- ---------Distance from nearer# building------------------------------------------ ❑ Distance to nearest lot line------------------ -------- - ----------- - ----- --------------/- ----- Remoueling and/or repairing (describe)__ _ ----- -r----- - ------ ______ - --- --- ------ --- ---- --------- ------------------------------------------- -----------...------•----•-------------------------- XaL�� - ---- ---------- --------------------------------------------------------------------------------------- ------------------------------- ----- ----------------••-.---------------------------------•---------------------------------------------•------------------- I hereby certify that I have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, State la13ws, and rules and gulations of th San Joaquin Local ,ealth District.jt. ,. --.-- __-(Ow r and/o Contractor) (Signed).. - --------------- ------------------- ----(Title)------- -- - -- - --- ---------------- By:•------- - - (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 BY--------------- --------- DATE------- t` ----------------------- - DATE-------�-----------•------------------------------------ REVIEWED $Y----------------=`--•----- ------------ -- ---------------------------------•- ----------- ------------------------ Bl11LD1NGPERMIT ISSUED--------------------------------------------------------------••---- ---------------------------- ---------------- -------------------------- DATE ------------------------------- Alterations and/or recommendations;----------___.--------------- --------------------------------------------•----------------- ----------------------------- ------------------ 3 F1NAL INSPECTION BY------------�-�-� --------------- Date-------------Z� ? "5 ------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore Street 814 North "C" Street 130 South American Street Trac California stockton, California Lodi, California Manteca, California y. ES---9-2M 10-52 Revised W-2100