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APPLICATION FOR SANITATION PERMIT Permit No. .. 3-- (Complete in Duplicate) A _ Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and-install th This application is made in compliance with County Ordinance No. 544. e work herein described. JOB ADDRESS AND LOCATION..__O.,�-------fi b-- Owner's Name__ .- ._W•__.-_-- --•'-------.� ----•- Phone JIM-605 1.�.CyP�-------•--------•------�-=------- - -. __ . -------•---- Contractor's Name--------- -- �/�,�?��`�f7!_..__..�.y�-C=--`-- -------- . ----------------------- --------- -•--------------••--------••- ------------------•---------•----•--------- •---------. Phone----- Installation will serve: Residence [_+partment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other-E] Number of living units: Number of bedrooms __7- Number of baths .___f. Lot size __,�-Q_Q-_!_- � G 1 -1 1 Water Supply: Public.system_ ❑ Comrnunify system ❑ -Private Depth to Water Table CSZ_'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam n Clay.Loam ❑ Clay Previous Application Made: Yes El Adobe Del-Hardpan El❑ No Construction:onstruction: Yes E9--No � `i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well------------------ Distance from foundation--------------------Material .______-"-__--"__-.-. - ❑ ��`f 'No, of compartments_____..__- - --.----Size--------------------------------Liquid depth_------------ ----------------------- Disposal ------- ' '� - - ------.,Capacity-•------- ------- ----- Disposal Fiel4: Distance from nearest well --------_-------- Distance from foundation__."__....:........Distance to nearest lot line.___.___.___.___. ❑ ^�''� iR f Numb_er of lines-------------------- ------- Length of each line------------------------- --Width of trench. Type of„filter material---------------._ - Depth of filter material____.__...__-.____"__Total length_____"____-------------- Seepage Dista cn to nearest well". 4 d- _"` ._Distance from foundation -- �i -- - __ p Lining material__ 1 S_ _.Size: Diameter-----_33 Depth__-" 4---------•----------- Cesspool• Distance from nearest well---------- ---.._Distance from foundation....................Lining material-__..___.__.__.__-__.__---- ❑ Size: Diameter----- --- ------ --" ------ ---- ----Depth-------------------------------------------- - ---Liquid Capacity- Privy: y Distance from nearest well Liquid ------- -gals. {� -------------------------Distance from' nearest building 4� t Distance to nearest lot line-------...._____-"-"._"•"-__•- --• . ............................ ------------------------------------------------ v Remodeling and/or repairing (describe):___-__-._ . r_ "" '��- J a ---------;--------•-_ ------------------------------ ----•------------------------------- ! hereby certify that I have prepared +his 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 Health District. (Signed) ---- --------- ,` By:. r and/or Contractor) -- a d/a ---: --=-•------------------------------------------(Title (Plot plan, showing size of lot Iota+ion of system in relation to wells, buildings, etc., can be placed on re arse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_____________ "-"-"" "- ------------ ------ ,'------------------. DATE-------�------------ REVlEWED BY -----------------------------------------=-- -- '' -------._.__ DATE------ BUILDING PERMIT ISSUED------=-- -----+ x = = ---------- --- ---- ----- ----- ------------ ----------- ----- DATE Alterations and/or recommendations:---- .............. ------ ----�.A_ - - --- - ________________---------------_-----------------_----------------------- - _ i __________________________________ ___ --------------------- FINAL INSPECTION BY:------ y -------`--------- '1 �' • Date-----=- ----- - --- ._:�--�_ ------------------------- ` SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California814 North "C" Street Lodi, California Manteca, California Tracy, California E-9-S 145446 ATWDCD