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1 APPLICATION FOR SANITATION PERMIT Permit. No. 4 (Complete j in Duplicate) = ,. z Date Issued --------_Ili 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 withCountyOrdinance No, 549. JOB ADDRESS AND LOCATION --7..--4c? ---------- ------------------------------------------------------ Owner's --------------------------- •-- --- Owner's Name . _!✓-= - ------------------------ --------------------------------------- Phone.- ------------- Ad 61 ress------------- -----------Address------------- Contractor's-Name- 1 l ------ - =* ---------- ----------------------------------- Phone- - Installation will serve: Residence ZL Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. -_,/-__ Number of bedrooms _,t7_ Number of baths /..-- Lot size ------r.--_ Water Supply: Public system ❑ Community system ❑ Private XK Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: Yes ❑ No IQ_New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: s D,istance from nearest well------------------Distance from foundation--------------------Material __-----.-___-.-----__--.----------------------- ❑ tY jof compartments------- -- ---------------Size------• ---------- -------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Disfance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-------- ❑ r of lines------------------------------ ----Length of each line------------= Width of trench _ Ty of filter material-------------------------Depth of filter material--------------.-_------Total length-------------•--•-----------____---___- --- Seepage Pit: Distance to nearest well___l --------Dista e r fo datj �--_.__.Distanceearest lot line- l _`_ Number of pits__-.--1.._-__.____-Lining mat nal- -__ ', iameter----- Deptn___.��------ ------------ 1 Cesspool: Distance from nearest well--_---------_--Distance r m oundation....................Lining material___-----_--__-----_-_-------_------. ❑ Size: Diameter------ -- -----------Depth------ ---------------------------------------------Liquid Capacity--- •----------------- --•--gals. IA 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, Stat";s?and rules and regulations of the San Joaquin Local Health District. (Signed) ...- t,.-1� ---------- --__.----.(Owner and/or Contractor) ------ -- --- ------- - --------------------------(Title)-- ----------- ------------------------ (Plot plan, showing 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----------------- - -- -- - •------------•----------- DATE------ , ------REVIEWED BY BY -------- ----------------------- ---------------- DATE---------'------ -• -------------- BUILDING PERMIT ISSUED------------ = =---------------•--------------------- ----------------- DATE- Alterations and/or recommendations:--------------------- - - ------------•----------------------------•----------- ---- - ------------ -------- - ---- -- - - - L�'' ------ - ---------- = -- -- 1O --- ------- ••-----_---------------- ---------- --- ---- 1- Z/----- ---------------------------------------•------ ----------------•-------------- -- ---- FINAL INSPECTION BY:------- ------------•---------------- Date--- 1 ___---- _ SAN JOAQUIN LOCAL HEALTH DISTRICT f30 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 A7w000