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APPLICATION FOR SANITATION PERMIT Permit No. .--.°__------�------ yk �� (Complete in Duplicate) Date Issued 114 Application is hereby made to the San Joaquin Local Health District for a pdrmit to const uct and install the herein This application is made in compliance with County Ordinance No. 549. �� JOB ADDRESS ANDCATION -- , &_/� '--l �"` Owner's Name•---- - 'eel`-0`��`'.------------•--------•------------------------------------------------------------------------------------- Phone--- ------------- ---•------ - Address -------- ---- -alu�--- --- ------------------------- - Contractor's Name-0000-11119"- '"--------------------------•---------------------------------------------------------------------------------------- Phone-------------------------------:--- Installation will serve,, Residence-& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _..,. Number of bedrooms _ `__ Number of baths _1_____ Lot size _ *011114" _____________________________________._ Water Supply: Public:system ❑ Community system Private ❑ Depth to Water Table ________ ft. � Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan-[] Previous Application Made: Yes ❑ No a New Construction: Yes ❑ No al FHANA: Yes [] No ❑ 4 TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) , Septic Tank: Distance from nearest welL,?__frb------Distance from foundation_ 4q----------.Material______r/_�_-.p------------------- No. of compartments-.-$------------------Size_?j' t ----------------Liquid d ______ Caacit __Ld"r1 epth---k----------- P y.-{i ------------ _ i'' r Disposal Field: Distance from nearest well_ _ °__.._Distance from foundation/D_____________Distance to nearest lot line_d2+___--____. Number of lines---/---------------------- Length of each line-_----- ---------------------Width of french-34.---------------------------- \ Type of filter material0___lJt _____Depth of filter material_Wy_____________Total length---2_4___1'__--_____-______________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- . ❑ Number of pits----=-----------------Lining material-----------------------Size- Diameter-----------------------Depth------------------------------ -- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.-----Lining material---------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------._. ❑ _ Distance to nearest:lot line.---.-.--- ----------------------------------------------=--' _ - - -- Remodelin and or re airin describe : - - �G '," - V - 9 p g I )� --- r- ---------- ---- ---•------•--=----------------------- ----- --------------------------------------•-------------------------------------------------------------------- ----------04 - -- - * - ----------------------------•-----------------------•----------------------------•-----------------------•---- :----=-----------------------•-••---------------------------------- j ----------------------------- --------------------------•-------------•--•-------------------------------- - , I hereby certify that 1-have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$, State la s, and rules and re tions of the San Joaquin Local Health District. (Signed] - ------- ------- ---- -- ----------------------------------- -----------------------------------------------------------(Owner and/or Contractorl --------------- --------------------•---....------------------------------------------------------------------------------------(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_ 1;2 -------------------------------- REVIEWEDBY-------------:-------------------------------- ----------------- -------------------------------------------------------- DATE---------•-----------...------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------•---------------------------------------- DATE---------------- - '-------------------------------------- Alterations and/or recommendations:---------------------------------- I -----------------------------------------•------------------ --------------- -= ----------------------------------- ---------------- ------ ----------------.---------...._-------------------------------------------------------------------------------------------•-• -------- " ' ------ I t1 ---------------------------------------------------------------------------------------------------------------------I--------------------------------------=-- --------------- --------------------------------- FINAL INSPECTION $Y:. -------------------------- Date ��J -'I�/ -----------''----------------------------------- 1 ,L• SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ,,� I Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M Revised 1.57 FY,CO.