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APPLICATION FOR SANITATION PERMIT Permit N�/.... t�__...... (Complete in Duplicate) ,J • Date Issued f1 Applicakion 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. No. 549. JOB ADDRESS AND LOCATION----------- Owner's Name_ 1..�2.> -------�--------- - ----- --- Phone------------------------------•---- Address......... tR. ----••---------------------------- ---------------- Contractor's Name___ ' G�/1A,. ---------�---- �a-------------------------------------------------'-................... Phone------------•---- ------•---------- Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __J____ Number of bedrooms __.Z,.Number of baths - -. Lot size ----- ------------___________ Water Supply: Public system C& Community system ❑ Private ❑. Depth to Water' Table --6-Oft. Character of soil to a,depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe LKHardpan ❑ Previous Application Made: Yes ❑ No [R., New Construction: Yes ❑ No N, 3 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200"feet.) -� Septic Tan� T -- -- -- ---- - Distance oundation-----------•--- ---.Material---- -------------------------------------- Qm -- -- - - ---Size --- depth------------------_-------Capacity----------------------- ❑ , Disposal Field: DiSfance from nearest well_________________Distance from foundation---------------------Distance to nearest lot line__.--_-__________ ❑'.. or of lines-----_-----------------------------Length of each line---.---'__.-------- -.----._.Width of trench------------------------- --------- lore of filter material-------------------------Depth of filter material------------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well_./_/V0-k_%.f_Distanceom foundation___�2:_0_-__..Distance to nearest lot Number of pits-------I------------Lining material--._- -Q-C.. '-Size: Diameter.--_ . __, ------Depth---a.. , ------------- � Cesspool: Distance from nearest-well-----------------Distance from foundation--------------------Lining material--------------------------- Size: Qiameter Depth -----------------------.----- Liquid Capacity gals. \ Privy: Distance from nearest well-----------------------------------------------._Distance from nearest building.----------__________--_______.._._-_____. . ❑' - Distance to nearest lot line-----------------------------------------------=---------------------------------•------------------ = t Remodeling and/or repairing (describe)---------------------_--------------- �k ---------------•------------------•-------------••-----------•-----•-----••-•------==-------=-----------•--- -----------------------------------------••-•------------ --------•---••--•---------------------------------- ------------ - --- ---------•---•-• •------•-----------••-------•-------------------- ------------•--•---•--------•--------•------------------ --------------------••--------------------•----------- -----------------------------------------------------•-----•----••-•--------------------------------------•- -•------------------------------------------------------------------•-----•------------------•--------------- VZ 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 regulations of the San Joaquin Local Health District.. ^ (Si 9ned)•---....P-------- -- - --''�-- -----�-�--�-xv�..-----------------=------- -•-•------------------------------------ --- ---[Owner and/or Contractor) -_ ---------------------------------------------(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------ REVIEWED BY ----------- ------------------------ ----------- -- ------------------------- DATE------n ,�---------- BUILDING PERMIT ISSUED------------------------------------------- QC-°j �� ----------------------------DATE------- •------�---�--------- -------------------------- Alterations and/or recommendations:------------------------ ---- ---- ------- .---__ --------------- -_ -- "�'`�-�=�----_1----------- .. - -._.. -- ---------- --------------------------------------------------------------------------------------------------------------- ---------------------------------------------=--------------- --- ------------------------------------------- FINAL INSPECTION BY:-- --------- ------ Date------- _L-) `.` _ ------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT J 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9 7a 44G AT—D „