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APPLICATION FOR SANITATION PERMIT Permit o. ........ (Complete in Duplicate) I'A . 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-----------/P0 ------ G�--------------------------- -------- Owner's Name------ --------fit --------------------------- ------------------ ------------------ Phone-------------- --------------------- Address............le.al.... ------•--Address----........le.al..•. -1e.--7- /--- L.C..�--------------------------------------------------------•--•- - 1 Contractor's Name...--- ---- =-i 7`_= /I� _ ------------------------------------------------- Phone--------------•- Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __f_- Number of bedrooms _..'Number of baths ..�___ Lot ------------ ----------- Water Supply: Public system,)j�af_Community system ❑ Private ❑ Depth to Water Table Oft. Character of soil to a dep#h..of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No4tA_ New Construction: Yesk-1 No ❑ W TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material __________._--__.-_______' __ ___•- :__.--__._.. ❑ ,Gof compartments--------------------- -----Size--------------------------------Liquid depth.--------- ---:----Capacity..--------------------- Disposal Field: risfance from nearest well-----------------Distance from foundation....:__------------- Distance to nearest lot line-___________..__- ❑ er of lines---_------------------------------Length of each line--------------.---------------Width of french----------------------------------- e e or filter material-----------------------------Depth of filter material--------------.--------Total length___________________:_ Seepage Pit: Distance to nearest well-1A14?7.-,k',._Distance from foundp i -__ __.Distance jo nearest lot line_____. _ Number of pits. Lining material_f�Et.c&i. meter- ' Depth-------��----------- Cesspool: Distance from nearest well----_---------___Distance from foundation_:------------..___.Lining material-----.._--_-____------______________- \ ❑ Size: Diameter------------------ -------------------Depth.---------------------------- ---------- ----------Liquid Capacity--------------=-----------•gals. O Privy: + Distance from nearest well--------------------------------------_----------Distance from nearest building -------------- -•--------- •--------------------------- ❑ Distance to nearest lot line........... - --- - ------------------------•----•-•--------------- --- � Remodeling 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, State , and rules-and regulations of the San Joaquin Local Health District. (Signed)-------- ------- ----- ------------------------ -------�4 ----- - __________________{Owner and/or Contractor) By:--- ----- �-'fd (Title) - - - (Plot plan, s owing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--•---------- ----------I- - �--------------------- ------------------ � --- - -- DATE-----:!5!•------------- ----------------------- -------- REVIEWEDBY------------------------=------------------------------ -- ---- --- ----------------------------------------------- DATE ---------------- --------------- BUILDING PERMIT ISSUED-------------------------- ------- - --------------------------------------------------------- DATE------•--- Alterations and/or recommendations — -------- ------------------------------------------------------------ -------------------- ~�' - ` �"'"r ------...... -- -- -------- --- --------- -------------------------- ---------------•--- -------- FINAL INSPECTION BY:. ---------------•-------- Date 4----1-1, r,)---------------------- 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 E� 9 145446 AT.... 1