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C APPLICATION FOR SANITATION PERMIT Permit No. _-___ 3 u (Complete•in Duplicate) /.2,I _ 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 i t Ordinan e No. 549. J08 ADDRESS AND LO T10 _________ o _ Owner's Name. - -----`�--------•----------------- Ph Address-------- .. �' l` �F�' G one. ----•--------------- Contractor's Name--____-- __-- -•-`----------- -- Phone _ __-•f7 .�_ z : _ ----- _ Installation will serve: Residence Apartment'House ❑ Commercial Trailer Court r ❑ ❑ Motel Other ❑ +. Number of living units: __y!__ Number of bedrooms__ Number of baths __f___ Lot size •------ Water Supply: Public system Community system ❑ Private [] Depth to Water Table��t. Character'of,soil to a depth of.3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ I Previous Application Made: Yes ❑ No9 New Construction: YesI- No ❑ • TYPE OF INSTALLATION AND SPECIFICATIONS: A(No septic tank or cesspool permitted if public sewer is available within 200 feet.) .l SepticTarilu< Distance from nearest well__-.__-_..______Distance from foundation____________________Material______--__".__._ ` ---- ---- -----. f /,.Dispos PJ o. of compartments -------Size--------•------•--------•-------Liquid depth----------------- Capacity f . -•--------------------- t 1 field: Distance from nearest well _____________Distance from foundation--------------------Distance to nearest lot line----------- Number or lines Length of each line- - ------------Width of trench ...... Type of filter material_________________________Depth of filter material-----------------------Total length_____________ -._________-..____._.._ Seepa Pit: Distance to nearest well / ,..,-r�.�'�__--__Distance from f ndation__,�.�-"--"-.Distance to nearest lot line__.__.---• 'r ] Number of pits___- ------------- maferial,; �� 9 tea,"'` 4.__.Size: Diameter_�t -------------Depth------r7 ---------- CQ Cesspool: r Distance from nearest well_________________Distance from foundation material__..__".._____.-___--_______,- 1 i ------- ❑ Size: Diameter--------------------------------------Depth----------------------------- ---------------------Liquid Capacity_-------------------------gals. �1 Privy: a Di'lance from nearest well- __---_ __- --___---.-Distance from nearest building }� [� ,Dis'�ance to nearest lot line..__...._.____-.__-___- -------------•---- .. 14 Remodeling grid/repairing (deser�.Lze):,*__ _ ! �----------------- --_p- r ,r - ` --- ---------- ---- ------------------------------- --------------- ------------- ---------- ------ -----•- ------••- -------------------------------------•--------------------------------------------------------- ---------------------------•----------------------- ------- I hereby certify tha I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, fate'.aws;and rules a d regulations,of the San Joaquin Local Health District. (Signed)--------------- ----- �' ` ----------------------------- ---------------4a � BY� ------------••-------------- � Tit ----- ---[ l • ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can ben re se sid i 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWI;D BYBY--- ----------------------------- ----------------- ---------------------------------------- DATE----V- - ------------------ -------------------------------- j-.- - -------- ---------------------------------------- ------------.- - DDATE------BUILDING- PERMIT ISSUE0.__________- ---- --- Al ns and/orreco n ions: � -,____-- � ' --- -- �--------/ ---• ----------- --------------------r ---------------------------------- FINAL INSPECTION BY:_.__ . _�- -.___._- Date 1 r __.. ---------------------------------- 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 �•`-"--"9 745446 ATWOnD