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APPLICATION FOR SANITATION PERMIT Permit No. ___..._-��-- (Complete in Duplicate) o k Date Issued _______________________ '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. 549. JOB ADDRESS AND LOCATION__..�)_el --- -------------- --`-____-- � p �. Owner's Name `Y! .- ---- _ uF_s = - -------------- ---------Phone Address-------- y. .Q w. ------------- - ------------- ----- -- 1 - Contractor's Name f.0 M. _ ------- .. Phone ' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other;-❑ Number of living units: __J__-_ Number of bedrooms _ - Number of baths ___)---_ Lot size ---- --------- Water ------------- Water Supply: Public system 10—Community system ❑ Private [] Depth to Water Table --------- ft. Character of soil to a dep+h of 3 feet: Sand ❑ Gravel E❑ Sandy Loam ❑ -Clay.Loam ❑ " Clay ❑ Adobe Hardpan ❑ - r Previous Application Made: Yes ❑ NoV New Construction: Yes--4tNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: w (No septic tank or cesspool permitted if public sewer is available within 200 feet.) # Septic Tank: Distance from nearest well-_�'!-.(�`1�1,(]istance from foundation....lb- _ Material --- ----------- No. of compartments._."-----------=---size---- ` - -- --�� ---._Liquid depth--------- -----------Ca Capacity..y• ------- j.. Disposal Field: Distance from nearest we l,.__.a. istance from found tion__.4_�---------Distance to nearest 19t line__ ____ -•-- Number of lines_-____.__ ______ h_.___- gth •f each line_ --_, . _-:_.Width of trench._- '" -_ Type of filter material- �-- ,} ter mat ial__._. -------Total length-------�.__Q __________________ 5 Distance to nearest well______________________Distance from founda on--------------------Distance to nearest lot line_____._._________ A Number of pits------------------__--Lining material_-------�--� -Size: Diameter------------------`___Depth.-------------------------------- sspool: Distance from nearest well---------------"Distance from,foundation_-_--.-_..___-__.-.Lining material----_.-----_-----___._._.______-_.__. ❑ Size: Diameter--------------------------------------Depth------------------------------ ------------------- --Liquid Capacity - gals. Privy: Distance from nearest we]----------------- --------------------------------Distance from nearest building- __.---________ - 1 ❑ Distance to nearest lot line- ----------------- = `�---- Remodeling and/or repairing (describe):__--V-.---------------------------------------------------------------------------------------------- -------------------------------------------- r -------------- -----------------------•----------------------•------------------------•--------------------------------------------------------••----------•------••------------------------------------•---------------------------------• N ------------------------- --------------------•------••---•----------•------•----------------------------------------•---•-----------•----------•------------•-----------------------------•---------------- -------------- I hereby certify that l 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. � w (Signe d)...---- /?" Dpi` ----------•------------ --------------------------------------(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). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- - -fit ------------------------ -------------------------------- DATE------ - -• ----�---•--------- -- ------ ---------- REVIEWED BY-------------------------------- C� DATE-- BUILDING PERMIT ISSUED -- ---------'---------------------------------------------- --------. DATE.---------------------- *�� Alterations and/or recommendations:.____-_._..__ ___ y --------------------------------------------------------------- •--------------- ..`�............•-•------ ---------- ------------------- --- ---------------- -------------------------------.----------------------------------------------------_------------------- ----------- --------------- ----------------------- ------ ----------•-------------------•-----• ------•- FINAL INSPECTION BY: Date_ - ------ 5 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 ��'•+'—g 145446 ATw000