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APPLICATION FOR 5ANITATION PERMIT (Complete in Duplicate) Date Issped g A made is hereby ma� to the San Joaquin Local Health District for a permit to construct and install the work herein described. 's application is made incompliance with County Ordinance No. 549. JOB ADDRESS AND L9 CATION--------- 1P. 151a------ - -------------- ----------•---•-------------------------- ---------------•------------ Owner's -------------w----------------------------------------------------------- Owner's ,Name------ --------- ----------------------------- -- ------------ --------------------- Phone. -- -------- ------ Address--------- ------------------------------- Contractor's Name------------------ -----------f------ ---------------------------------------------------- ----------------------- ---------------- Phone------------ Installation will serve: Residence J4 Apartment House E] Commercial E] Trailer Court El . Motel E] Other it t er Number of living units: __J---- Number of bedrooms__-- Number of baths r.1----- Lot size ---- ---- A Water Supply: Public systerri Community sysfdm E] Private E] Depth to Water Table -------- ft. 11, Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loom [] Clay Loam [3 Clay 0 Adobe,< Hardpan E] Previous Application Made. Yes E] No Now Construction: YesV No F-1 TYPE OF INSTALLATION J:XND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well______-__-______Distance from foundation___________--_- --Materiai_ El No. of tompartmen.ts----------- --------------Size------_-------------------- ---Liquid depth------------------------_Capacity----------------------- 11; Disposal Field: Distance-from nearest well---- ------------Distance from foundation--------------------Distance to nearest lot line___.-__ -__ �...e l ❑ ine------- El Numbe-,of lines_- _-_ ------Length of each line------- -- - --------------_Wiclik of'trench------------------------------ Type o-T' filter material-------------------------Depth of filter material---------------- -----Total length---------------------------------------- See Dista' Jj �r p pit: nce to nearest well.-A---�_�-_ __Distance_l�om foundation---J_(n�------.Dl' t to nearest lot line _11Z.--------- Number! of pits....J-------------Lining maferial---lt��_ �ize: Diameter-- ---- --Depth......Z4----------7---- Cesspool: Distance from nearest well___--------------Distance from foundation----------------- -1 material if El Size: Diameter---- -------- -------------- ------- Depth----------------------------- ------- -------------- Capacity-------------- Liquid Capacit - - '!1 11 ------------------gals. Privy: Distance from nearest'well-,-------- -------- --------------------------.-Distance from nearest building -------------------- 1 Distan e to nearest lot line--------- Remodeling ine---------Remodeling and/cr repair1in!�g (describe)_________________________ _ --- ---I------------------------------------I----------------- -------- - -----------------------11--------------------- ----------------------------I------ - - --------- ---------------------------- -----------------------------------------------11 - -----------------------------------------------------------------•------------•---------•------------------- I-------------------- ------------------------- ------------I---------------------------------- ---------------------------------------------------------- -----------------------------•- ----------- I hereby certify that I..have prepared this applicafion and f hat'the work will be done in accordance with San Joaquin County ordinances, Sfaf I ws, and rules and regy in Local Health District. ,��fi?ns of the San Joaquin. - -------------------------I-------- ------ ------ --------- (Signed)------- -- ----------------- ---------- ------------- ---------------_-------(Owner and/or Contractor ------------- ------------ B -----------------------------I1.---•-........ ------------------------------------------------- -- --------------------------------- 1� ------(Title)-------------------1:---------------- ------ (Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be' placed on reverse side). it FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- --- -------- ------------------------ DATE -------- -- ------------- ------------------------------- REVIEWED BY__ 111 - � DATE_------------------------- ------------ -- -------------------------- -------------------------------------- TE-------- ---11 BUILDING PERMIT I5SUED-11 ------------- ------------------------------------------------------------------ DATE-------------- Alterations and/or recommendations:---------- ...... ............. .. 7 0---------------- -----------•=--- -----------------------�:----------------------------------- i--------------------------- ------------ 7---------- - ------��-d__A----I------1_-_1----------- - ----------------------------------------- ------a.-_�------------------------------------ --------------I---------- ------- ------- ----- ----- -------- -- ------- ------ - -------------- ---------- --- ---- ------ ------------------------------------------------------------ -------------------------------------------------------- FINAL- INSPECTIO N BY: .................. ------------------------ - -- ------ Date---- .L SAN ate----- 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 145446 AIWOOD L