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V - 1�1� APPLICATION FOR SANITATION PERMIT Permit No. ....0.1 (Complete in Duplicate) S� p Date Issued plica+ion is hereby made to the an Joaquin Local Health District for a permits"t c,}��:n�`'Li'trstbil`the workh i es ed. Th hs application is made in complia ce with County Ordinance No. 549. Y / JOS ADDRESS-'AND r-�-_ __- - ------ -,Vd.-U----D-Pqx- = d-I.R�..0. 4 ..... LOCATIO - Phone------------------------------------ Owner's -- --- ----------- -- -- 4 L Address 2 5 .57 -----?- Contractor's Name------- _� -¢- --- ----- ------ ------------------------------------------------•- Phone------------------------_-------- Installation will server Residence ®,-'A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: _)____ Number of bedreorns3-__. Number of baths -size ------/� ___ - ----------------- Water Supply: Public -system ❑'� Community system, Private F-1Depthto Water Table 4re ft. { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe KHardpan ❑ Previous Application Made: Yes ❑ No 5Z-,New Construction: Yes X No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) w Septic Tank: Distance from nearest wellPQ /__Distance from foundation_16_`____-__ __Material_ _<�..� .A_-___. -.v. FAL No. of compartments------- --------- . - 1 a__Liquid depth----- --------_Capacity...___��_ r Disposal Field: Distance from nearest well- cP_V._f_Distance from foundatian_f ._........Distance to nearest lot line__`) Number of lines--------- Length of each line----------- --.-.Width of trench._____ _ _________.____ Type of filter material_____ .�.?Depth of filter material____./-_�_.-!.__._Total lerigth______�_„5 __ ___________________ Seepage Pit: Distance to nearest well. 1� `� _____Distance fr foundation___. -------_____.Distance to nearest lot line----- _�_. Number of pits----- ..--____Lining material. 9 Diameter------- Depfh____- _ - ______. Cesspool: Distance from nearest well-----------------Distance from foundation_...........------- Lining material _.____..------t___._______________. Size: Diameter--------------------------- ----------De th---------------------------------------------------- _Liquid Capacity ---gals. k'1 Privy: Distance from nearest well---_-------------------------------------------._Distance from nearest building---__._______._________________________- ; ❑. .� Distance to nearest lot line--------- -----------------•------------------------- -----=------------------------------------------------------------------------------ R emodelin -----------------------Remodelin and/or repairing describe --------------------------- --------•--- --•-••----- - -------------_--- -- ------------------------------------------------------------------------------------------------------------------------------------------------ - -- ------------------------- ----------------------------------------------------- ---- -•- ------------------- - -------- . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta aws nd rules and regulations of the San Joaquin Local Health District. h 1W Sined ---- ----------------------- ---------------------------------------------(Owner and/or Contractor) By:-- -----------------------•--(Title)-------� t-------•------------------------- (Plot plan, showing size of lot, location o system in relation to wells,-buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE------�0------------------- :: REVIEWEDBY--------------------------------------------- -------:-- ------------------------------------------------------ DATE--- ---------=N-- ---------.-.-_------------------------ BUILDINGPERMIT ISSUED----------------------------------- DATE - = ----------•----- --------------- Alterations and/or recommendations:----------- (� - t: --- ------ - ------ -- - r --------••--------------------------------------•----------•---•---•---•-----------------------.------•-------- FINAL INSPECTION BY:___-- ----------------_------------_--- Date_...__f4.�_.L�1._�_�_._ - -- ------------------------•-•- 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 ES-9 545446 ATWOOO - 'f