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VI/ . APPLICATION FOR SANITATION PERMITPermit No- ----- (Complete in Duplicate) /1I / Date Issued _.--.- __3/ - __ l 4zr Appliceion is hereby mare to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. , -------------_------- JOB ADDRESS AND°LOCATION --------- --- : _...- Owner Name---^ ------------------------------ , ---------- Add ass Address --- ---------------- ----------------------- -----=-----------------•----------- cfor's NameContra Phone 1--------------- Installation -•Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑ Other ❑ Number of living units: ---- Number of bedrooms Number of-baths ___�_-_ Lot size __�__)__ ---- -6"U-•___..____________________ Wafer Supply: Public system E_--community system C] Private ❑ Depth to Water Table `—S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy .Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0---Hardpan 0 Previous Application Made: Yes ❑ No New Construction: Yes.R-_`No ❑ TYPE OF'INSTALLATION AND SPECIFICATIONS:-! _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TI#c;, Distance from nearest well Distance from foundation-------------------Material__--__.-___.--------T-------------__-----_--._. r / No. of compartments-- -----------------------Size--•-----------------------------Liquid depth--------------------------Capacity-.-------------------- Disposal of Distance from nearest wefi-----------------Distance from foundation-------------.... _.Distance to nearest lot line_--_-_;-_---_-. Number of lines-----------------------------------Length of each line---_--------------------------Width of trench--------------------------------••- Type or filter material ---._.____--------------Depth of filter material----------------------Total length__.---.----_-_-.--------___-. Seepage Pit: Distance to nearest welL. ^r�_______Distance from foundation{------Distance to nearest lot line- ._ Number of pifs__--- ----------------Lining material_. A,/----..Size: Diam ter_._ _.__-__..__..Depth_.._ __-_____.____-_______ Cesspool: Distance from nearest weil::'�----------_Distance from foundation------------------- Lining material.---_-_.,___-__-.-_--___-_ -_---___--. ❑ d Capacity-----------------•----------gals.Size: Diameter - -----------=--------- #�-- Depth------------- •-•------------------ - - ------Liquim Privy: Distance from nearest w4...... --------------------------- ---Distance from nearest building---____________________-----------------. 4 ❑ Distance to nearest lot line--------------------------------------------------------=----• Remodelinga 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 laws, and rules and regulations of the San Joaquin Local'Nealth District. (Signed) ------------•---------------- -----------------------•---••--------------- {Owner and/or Contractor) {Title)_ BY= = ------------------ (Plo# plan, showing size lot, location of system in relation to wells, buildings, efc., can be placed on reverse e).�I1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY w---------- -------------------- --•-------------- ------ DATE-------------- REVIEWED BY------------------------------- --- ------ DATES -- - ------------------------- ---------- ----- BUILDING PERMIT ISSUED-------- ---------------------------==------------ --------=-------- -----'--------- ---- DATE-.-.- V--- -- --------------- Alterations and/or,recommendations:---- --..-----•--------------------------------------------- .....•__--------------------- - . ..�1� -------------- --------- ----- -. ------------------------------------------------------------------------------•-----------------------------••--------- ------------------------------------ ' �- INSPECTION BY.. FINAL ��4 -------------------- . -- ---- Date---/ -- ----------- SAN JOAQUIN LOC L HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California h Tracy, California E5-9 145446 AT11100D ,