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APPLICATION FOR SANITATION PERMIT Permit No. 'L/..-k3_ (Complete in Duplicate) Date Issued o_' -` ------- Applica*ion is hereby made to the San Joaquin Local Health District for a permit csructyand install the work herein described. This application is made in compliance wit Pe , Coun y Ordina ce No. 549, �S » 2�o— r JOB ADDRESS AN CATION.- - . - - ----- -- Owner's Name-_ 01. ---• -------------------------- Phone----- ---"-r '. Address------ ------ �[,� - �1`�- � Yf _ --_••----------------------- {' Contractor's Name------------- - Phone Installation will serve: Resi ence Apartme ouse ❑ Commercial ❑ - Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - ----- Number of bedrooms- Number of baths -/--- Lot size -------------- Water. Supply: Public system ❑ Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay LoaClay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes j ' No ❑ '' \\ TYPE OF INSTALLATION AND SPECIFICATIONS-Y~� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance-from nearest well—:5 _Distan-from founda ion__-fQ__' eri No. of com artments-- +: Size' .' L•q P Capacity P Liquid de th Ca acit -. Disposal Field: Distance from nearest well. Distance from foundation/ ' ..��. - - - -_---.Distance to nearest lot line--f- Number Number of lines_-_.-- ��--__ Len th of each']ine '_-_` r ----- 9 1` _.Width of trench-- ------c Type of filter material,-&- � _-Depih-of filter material---_S _________ �.. .. Total length ------. - -------------------- f Seepage Pit: Distance to nearest weff----y�aa__---_Distance from f Vndation_./-Q-4__ Distance to-nearest lot( line----_.�---_Number of pits.-.-_�-------------Lining material .-_-- ___-.Size: Diameter-.-. '. ' � � Deptn- �r --------------- 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__--.-.--.._--"�------------------ " - ---------------------------- --------- -------------------------------- Remodeli�g 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 Countyi ordinances, State laws,--and ules an ulations of the San Joaquin Local Health District. , 9 {Si ned ) t -- - ------------ -- �onreve' (Oner and orContractor) By:. ��-- -- ------------ ------------------------------------------------(Title) _- - --------------- - -(Piot plan;showin size of to , location of system in relation to wells, buildings, etc., can be`� erse sid FOR DEPARTMENT USE ONLY (� s ---------------- APPLICATION ACCEPTED BY----------------------- --- -------------- -----------•- •--------------- DATE---------- ' REVIEWEDBY -------- ----------------------- ---------- ------------------ DATE----- UILDING PERMIT ISSUED--------------------=------------ --------------------------•- -- DATE------------------- Aterations and/or recommendations:---------------------- �y; ------ , ------- -------------------------- W-:4- --------- ----------------------- ------:. lt-:- � --- -------------------------•----------------- ---•------------------ -------------------- ----------------------- --- -------- -------------------lvl-eje----- •---------- FINAL INSPECTION BY,'---------- i ------- - ------------- Date--------- `'-t�ff-.. .3~ � SAN JOAQUIN LOCAL HEALTH DISTRICT f30 South American Street 300 West Oak Street 132 Sycamore Street - 1814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M "ite sad W-2100 "