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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) y, Date Issued `- Application is hereby,made to the San Joaquin Local Health.District for a permit to construct nd i_nlsfall the wo herein described. This application is made in compliance,wit o ty O finance No. 549. �0 A:5— JOBZze ADDRESS A LT ON--,r---- ----- - - G s- --------------------p -----�U P YrS b ISL e..t/v� Owner's Name ) ---- - Phona _ Address---------- --- ---------------------------------------------------------•- •-------- � - - fir - --------- es---z.' Contractor's Name--- --5---- ►- -------- -------------- - ------- -------- ----------•---------------------- Phone----------------------------------- r -------------- - --- --------- Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Mot I Other {� Number of living units: ____�__ Number of bedrooms __ --Number of baths ____/___ Lot size ______a _-_ _____`----- _--______ Water Supply: Public system ❑ Community systemPrivate ❑ Depth to Water Table-� �ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam gg—'CI•ay Loam❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: Yes ❑ No �New Construction: Yesto•❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public fewer is available within 200 feet) D 01 Septic T k: Distance from nearest well--4-----------D'rstanee ofo+,�nda#ion __ _ _______.Mate ial�_ 1 _© �__._. No. of compartments 'Z- Size c� `-_-" ------Liquid depth------ r Capacity ,. Disposal Id: Distance from nearest well (P _-Distance from foundation ___Distance to nearest lot III a Number of lines- ••--/- � Length of each line-----� Width of trench CtJ ------------- . tt �t-- Type of filter material-----I 2 Depth of filter material___.__ . Total length_______ ________________ Seepage Pit: Distance to nearest well_ __________________Distance from foundation---------------------Distance to nearest lot line................. ❑ Number of pits____ Lining material_____________________Size: Diameter------------------------Depth Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material..________-• _._......-_____-. ❑ Size: Diameter--------------------------------------Depth--------------------------------- - -------------LiquidCapacity --------- --gals. Privy: Distance from nearest well.- ----- ------- --•------ ------- •--Distance from nearest buildigg------' _ ------ ❑ Distance to nearest lot line----- - ----• -- ---------------------------------------------------------v_ s Remodeling and/or repairing (describe):---------------------------------- ---------------------------- ------- ............................................... ------------------------- ---- ------ ----- ---- --- ------------------------•------------------ - -------- ------ -------- -- - -------- ------- -------- ---•------------- hereby certify that I have prepared this application and that the work will be doge in accordance with San Joaquin County ordinances, State laws,'and rules and regulatio of the San Joaquin'Local Health District. s (Signed) - - ---- --------- - -----(Owner and/or Contractor) By---------------------------------------......................................---------------------------- --------------------(Title) ------------------------------------------------- ------ (Plot plan, showhintg slid of lot, location of system in relation to wells, buildings,etc., can--be p♦aeedgr¢rem s#de). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ---- --- -------- --- ------------------------- --- --------- DATE –40t----------- �J REVIEWED BY ------------------ ----- ------------------ ------ DATE----- •---- BUILDING PERMIT ISSUED......................... -------- --- --------- -----•------- --------------•---- DATE .--••-- -------•--• ---- •----•-•------- Alterations and/or recommendations:-------------------------------------........ - -•------ ---•---- -- •- ------------------.. __..r.--- --.............................. FINAL INSPECTION BY: --------------------------- Date. Q..................... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Sheet 300"West'Oak Street 132 Sycamore'Street 814 North "C" Sheet Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 8=51 Revised W-2100