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x 3 nn gg q •. APPLICATION FOR SANITATION PERMIT Permit No. (Com lete in Duplicate) PDate Issued Applica+ion is hereby made to the San Joaquin.Lvcal Health District for a permittoconstruct and install the work herein described. This application is made in compliance with County Ordinance No. 549 ---------------------------------------- - JOB ADDRESS AND LO ATION____--____ �---Q----- -----------------------••---------- Phone._._ . Owner's Name__.._ e� - - AddressO'`Ct�L.. ---------------•--------------...--••-----------=---------------------•- -------------------- Contractor's Name.__ t --- Phone------------------------------ ---- Installation will serve: Residence (� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other 0 Number of living units: -1--- Number of bedrooms . -: Number of baths ' Lot size___ - -- .____ C'------------------------- Water Supply: Public system ❑ Community system ❑ Private'%L De'pth'to'Water'Tablee.p_ ft. Character of soil to a depth of 3.feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe KL_Hardpan ❑ Previous Application Made: Yes ❑ No X_New Construction: Yes No ❑1 " V TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A Septic Tank: Distance from.nearest well--- i -9rstance from ,foundation__.__= -----------Matj�rlat:_____._.__ - �---Liquid deP.th--------" ------- Capacity-No. of compartments-...��--/---�----Size_. �_.�_+�- d .�Ca acit .._____. Disposal Field: Distance from nearest well..f_�!' �--Distance from foundatiion_______.R___._-Distance to nearest lot linw..l_ ____. Number of lines-----°_____--- _ Length of each line---___.$ )�-.� ----Width of trench----r-�__________________ T n Type•_oT filter-material-__1 a 4 ___..� .-Depth of filter material----f-9---------Total length_____1..-_50- _ Seepage Pit: Distance to nearest well_114-- . Distance f o`/m fount€ation._ -_�_O.__.Distancer�o nearest lot line-.-- - Number of pits----- // _Lining materi ci- �ze: Diameter____�__�--___.Depth_.,._ f Cesspool: Distance from nearest well________________Distance from foundation 7._ - Lining material-_.;_.__________.._._-_-.-_-__-____._ ❑ ----------------Depth--------------------------------- ------- -- Liquid Capacity-.----------•- -------gals. -Size: Diameter--------�----------- -- - - Distance from nearest well_.._._._-______________________________________Distance from nearest building_: Privy.i :' ..._.. r' _ . _. : ❑ Distance�to nearest lot line------------•----- --------- --------------=---------------------••---------------- Remodeling and/or repairing (describe):--------- ---------------- ----------- - .--- -------•-••-------- ------------------------------ -----•-------------•---•-------•--•-------------------- - -- ---------------•------- -------- ------•--•--------••--------------------------- :-------------------•------------------•----------••--------- ------ ------------------_--__-----------------•-- - I hereby cerViat I haveprepared this application and that the work will be'done in accordance with San Joaquin County ordinances, Sta# and rules and regulations of the San Joaquin Local Health District. (Signed I------ ----- --• ---••------------- :' —-------- r I caner and/or Contractor) -------------- By:----- ---•--- ----------- - (Plot plan, showing size of.lot, location of system in relation to wells, buildings, etc.,"aan 'be placid on reverse side). FOR DEPARTMENT USE ONLY : I APPLICATION ACCEPTED BY-------------------------- -----r---- --D--A---T---E---. REVIEWED BY - . --------- ---------- DATE-----------•-- - BUILDINGPERMIT ISSUED----------- -------------------- ---------•------•------------------- ------------=--- DATE-------------------- Alterations and/or recommendations:---=-- = = = 1.i-s - -------- - -- -------------------------------•---•------- -- -------- ------ ---------- ----- ------------ . ------- - ----------- ---------- -------- ------------------ --- § FINAL INSPECTION BY:. - Date:. Jf � - 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 E5�9 145446 ATWO-