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APPLICATION FOR SANITATION PERMIT Permit No. 3 ___/.. (Complete in Duplicate) �- Date Issued 2applic Atmade e to the San Joaquin Local Health District for a permit to construct and install the work herein described. Tcompliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------- ----- --- .. ---------30•---- --'" ----- -----------•---- -- -- - Owner's Name-----------------------•-------•----,DG7~-n- G1............Dxv&i-------------------------------- -------------- --------- Phone------------------------------------ Address yr ----------------------------------------------------------------------------------------•--------------- ... 1 ca - = Contractor's Name- =� ------I ---------•-•---- ------------------------------------------------------------------------------------------- Phone----- -----------•--------•------- Installation will serve: Residence 5q Apartment House ❑ -•Commercial--[]--Trailer-:Court„❑,©M_ot I ❑ Other ❑ Number of living units: ___/__ Number of bedrooms -2f. Number of baths __�___ Lot size ____Q_Q---A� �a____� r � Water Supply: Publics stem D Community s stem rivafe Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:, Sand E] Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay ❑ ;Adobe® Hardpan ❑ Previous Application Made:,Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE.OF INSTALLATION AND SPECIFICATIONS: . (No septic tank or cesspool peal' itfecl if publi fewer Is available within 00 feet.) p�� Septic Tank: Distance from near$st w: 114__�,Q__-___Distancy from four�lation_._.� _.�' Mat ri 1_._ _ ----_--------. ,/ I t No. of com artmens -- __ _ - -._Size_ �[ - X'`,1_-..___Li Liquid Beth -___ _ t Capacity ' ® p q p k -------------�- ---- f Disposal Field: Distance from near1f w,edl_-- ___--._.Distlance from foundation;_--. -.�--.-_- .Distance to nearest lot line-__ Number of lines-- ------------Length of each line_ d____�_'-'��___-Width of trench---__-e2_ - r• w _ Type of filter material - �_C*______Depth of filter material------lS ---------Total length_-____A. r�__________f__3_2_ Seepage Pit: Distance to nearest -ell_--_.______+____-___Distance from foundation---------------------Distance to nearest lot line-----.-__________ ❑ Number of pits-----Z-------------Lining ma45ia1"'."""° "`"" '"Size:'Diameter_------------------D�epth-------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation---_----.__-------- Lining material._.____-__-_------___----____-______ ❑' Size: Diamefe-i---#-----------------------------Depth----------------------------------------------------Liquid Capacity-- -----------------,-------gals. Privy: Distance from nearest well------------------------------------------------_Distance from nearest building-____----_- _-____________.________-. ❑ Distance td nearest lot line------------------------- ---------------------------------------------- Remodeling ---------- ---------- Remodeling and/or r pair = ing (describe)---------------- -------------------------------- Ic- -----------•---------------------------------------------------- - --__---- -- -------------------------------------- — --------------- -- y • --------------------- -----• - - -- ---•-- --------------- 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 rules and regulation -of the San Jo quin Local Health District. (Signed)--- - - ----I-- ,�r t U------ ---- - -- -------------------------------------------------- ----(Owner and/or Contractor) B (Title)_ ( P '----- -------------- --- ---- -- --------•-----Y-•-•- �-�---•- -- --- - --------------------------9---------•-------- p n'reverse side). Plot plan, showin size of lot, location of system in relation to wells, buildings, etc., can 6e laced o - F EPAR ENT ?AE ONLY APPLICATION ACCEPTED BY--- ` - ------- ------ DATE------- REVIEWEDBY - --------------- ----------------------------------------------------------------- DATE BUILDING PERMfIJ� ISSUED------------------------ tn------------------ --- DATE Alteratio an /oh-.ecommendati ns:-/___`_ w-.._ ,.� �� t _ ___-_ do ---'•- ------------•---------- ----------------------------------------------•---------------------------------------------=------------ ------------------------------------------------------------------------------------------- ------------- --------- -------------------------------------------------------•-------•------------------------------------------------------------------------------------------------------------------------- --------------------------- .-.. -------------------------------------------------- ---------------------------•---------------------------------------------------------------- ---•-----•--- / n3 --------•--•---•------------------------••-- FINAL INSPECTION BYi----------------- --------------- 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 E5- 2M 10.52 Revised W-2100