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APPLICATION FOR SANITATi.4,N PERMIT Permit No. - '� I i (Complete in Duplicate) �77 Date Issued ____-_�1--_____ ( � A tion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein sc�lSed. v SPP 'his application is made in compliance with County Ordinance Na. 549. , JOB ADDRESS AND LOCATION__________-l - - ---- ---- � NII �'Ili -- Phone- bwner's Name-----=--- ----��-- - •-- -----------------q---- -------------- ------------ ------------ -------------- ----------- � Address--------------I•- - ------7 '�--- �"'.. jLt,.. ` ... one III iContractor's Name-------------- ..� - -------------------------------------------- ------------- ---------- ------------------------ --------- Ph Ilnstallation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Oth[er ❑ . I _ __ C - "`-------------------- Number of living units: ___�-__ Number of bedrooms _ Number of baths _�___ Lot size _--_- 1 . ater Supply: Public system ❑ Community system [] Private �, Depth to Water Table 1? ft. � haracter of soil to a depth of 3 feet: Sand n Gravel E] Sandy Loam [- Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Application Made: Yes ❑ No ©- New Construction: Yes es aq No E] G� - TYPE OF INSTALLATION AND SPECIFICATIONS: — F Y�r� , available within 200 feet:-- - (No-septic tank or cesspool permitted if public sewer is } Septic Tank: Distance from nearest well__-___ ' Distanc from��fou n ation___-kv ___-Material_---__ ------------ -------- ---_--p_ y----- iI No. of compartments 17-- Size----- Liquid depth------ Ca acct i Disposal Field: Distance from nearest well__ 0-------Distance from foundation -__�_____ Distance to Weare o e_ __Length of each line Width of trench_ n- -----. __� Number of lines---------- t� f 2 x t t ,. ,r g L------ - ---- Type of filter material-7Y2 --__. _ Depth of filter material________ ___________Total length I.Seepage Pit: Distance to nearest well_________________ _____Distance from foundation--------------------Distance to nearest lot line_____---------- i ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------.Depth------------------------------C. r Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining mat erial___.-_______-_______----------------. ❑ Size: Diameter-------------------------------------Depth---------------------------- ---------------------Liquid Capacity----------------------------gals Distance from nearest_bdildin - �- Privy: Distance from nearest-well--------------------------- ----- 9 - I I ❑ Distance to nearest lot line---------------------------------- ---------------- ------ li - Remodeling and/or repairing (describe)----------------------------------------------------------------------------------------------------------------------------------------•----------------- 1--------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- - - --------- ----- -------------- ---------------------------------------- I � I I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Owner and/or Contractor) (Signed) ------------------------------------------------ - -----� _ - K . Tale j (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t i FOR DEPARTMENT USE ONLY I ---------------------- DATE--------- � � �_` APPLICATION ACCEPTED BY k I REVIEWED BY -----------------------•-- DATE---------- --- rJ �" ------- -------------------- - ----- BUILDINGPERMIT ISSUED---------------------- ----------------- DATE------------------------------------------- ' Alterations and/or recommendations:___- '"- - -'-- --- 1-- = '�� '� '� :7 i , I ----------- --------------------------------------------------- ---- iI ------- ------- ---------------- ------------- ----------------------------------------------------- ---- ---'---- ----------------------------- ---------- --------------------- = ------------------------------------------- -- -��-- FINAL INSPECTION 13Y:.- Date - ,' SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Street I 130 South American Street 300 West Oak Street 132 S Y Stockton, California Lodi, California Manteca, California Tracy, California I E5-9-2M B-51 Revised W-2100