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APPLICATION FOR SANITATION PERMIT Permit No. .__ .__� (Complete in Duplicate) �f _..�... ..�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 A Q. LOCATI N.._J�._(_°-- ------.k l-- 1 � ke , Owner's Name__ _ -------------------- Phon Address__._..-6 -2 } ------- ------------------• --------------- Contractor's Name..., `---`-- --------- -�' - --------------- Phonal a._` P lfv A Installation will serve: Residence.M Apartmeri House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---=___ Number of bedrooms _ __- Number of baths ___1___ Lot size -----67��---------- Water` Supply: Public lsystem"❑ `Community system El Private V Depth to.Water Table --------- ft. Itili Character of soil to a depth of 3 feet: - Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ef Hardpan ❑ 4 Previous Application Made: Yes ❑ No New Construction: Yes A No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: n from nearest well_________________Distance from foundation----�C'— -----.Material____�1? i _--_-------_----__•--- ❑ No:.o compartments--------------------- -----Size--------------------------------Liquid depa h--------------------------Capacity----------------------- Disposal Fie` Lance from nearest welf-----------------'Distance from foundation----! -----------Distance to nearest lot line----------------- 1 ❑ u�Pber of lines-----------------------------------Length of each line----------------------------- Width of trench Type of filter material-------------------------Depth of filter material---------------------_-Total length--'------------_----- �.. " ` r.: Seepage Pit: Distance to nearest well __�6_a_________Distance from foundation____d�v____t __.Distanfe to nearest lot line--.7- f__.- p Number of its.------- g �°' r....3!' j ------..Depth-----�41----------------- Cess ool: Distance from nearest well___LI�I�____ Distance from foundatonDiamete F ,, ---=-.Lining material----------------------------------- I --------------- ------------ El Size: Diameter-----------------------------------------Depth =•---------------------------=----Liquid Capacity-.. ------------------------gals. Privy:; Distance from nearest well-------------------------------.-----------------Distance from nearest building_____..__________--______-- ----------- El 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 laws,'and r and regulations of the San Joaquin Local Health District. I s } _ (Signed)------ --�J Owner By:.-- - -- �_. ----------�_�-------- - -- -------------------------------------- (Signed) - -----------------------•---------------------(Ti}:. ------------------Ow and/or Contractor) t :ate le)------ f---- r (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 .. f ----------------------- APPLICATION ACCEPTED BY --------- ---------------------- --------------------------- DATE----------- REVIEWED BY-------- ------------------ , - -- --------- ----------- ------ - ---- =---------------------- ------------•--------- -- •-------- DATE---- -----------�.----------- -------------- BUILDING PERMIT ISSUED"-----=-=---------- --------- - ------------- ----------------------- DATE_.- -- ---------------------------- Alterations and/or recommendations: ---------------------------------- -------------------------------------- -------- -------________________________________________________ v7 _--__.____.__________________________-_-__-_--._____--_....____._-._f._._._-_- . ________________________________«_-______________..._____---_____------ -------------------------___________________________________--�--�-- ------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:_•-� >2J-- -------------•---- - • Date- 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-9-2M Revised W-2100