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I 0 X APPLICATION FOR SANITATION PERMIT Permit No. ...... �8�_`� (Complete in Duplicate) / Date Issued ___ __/�/..5�-- Application 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 with County Ordinance No. 549. JOB ADDRESS AND L _CATION_________�8��Z_ _ S,::5 9).4,0 Owner's Name -------------------------------------------- Phone------------------------------------ Address, ......... -•--------•-----•--••- - `. ` Contractor's Name • ----------------------------- Phone---/K---#e 4 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f____ Number of bedrooms __`Z--Number of baths ---/-- Lot size ___ ____ __f_ ______________________ Water Supply: Public system K Community system ❑ Private ❑ Depth to Water Table .r�____. ft. Character of soil to a depth of 3 feet. Sand [–❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe k Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic��f ce from nearest well__,__.__.___.___Distance from foundation__._.-__.__..____-Material------------------______________________.___._- ❑ compartments------------------_----Size--------------------------------Liquid depth------------------------.-Capacity--------------------- p ��74L4Bistance from foundation____ r bis osal Field: Distance from nearest well. _- _____._.Distance to nearest lot line,/1_0--- Number of lines---------- ---_�___r---- ---Length of each line____�C,t__`---_._r,.-.Width of french.___Z1_�---------------•-_ Type of filter material ____.r`>RDepth of filter material____.__/9__...___Total length___-.-.-�d________________________ Seepage Pit: Distance to nearest well.____�l0-PLtU_Distance from.found`aation___�45_____..Distanc"Distance nearest lot line------ � IX Number of pits.__._.__.---------Lining mate ria l__��_ _ix�s�$nte: Diameter-----.5�- Depth �1 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----....._____._____.____________-__ ❑ Size: Diameter--------- -----------r----------------Depth------ -- ------------------- ----------------------Liquid Capacity---------------------------- Privy: Distance from nearest well----------------------_----__=_-----------------Distance from nearest building___.____.__.__________.....__.___:------ , y O Distance to nearest lot line--•-----------------------------------------------------------------------•-------------------------------------- -....--------------�----- Remodeling 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 County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. (Signed).---.....__,_ ------ `--- ------ --- - .-----------.-.-.--.(Owner and/or Contractor) By:. -- ------------------------------------------(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--------- --- TE--------=-------------- ------------------------------- REVIEWED BY-------------------------------------- ...... �� ----------------.-------- --- ------------------------- TE------ • ,� - BUILDING PERMIT ISSUED--------------------------- ----- -------------------- •--•---------------------------------------- DATE-------------------�3-`---- ----• ...----------•-------- Alterations and/or recommendations:---------- ------ ---------- -------------------------------------- -------------------------- --------------------- --•---------•-------------••--•--•------------- ---------- --.- -.- --7f- -- - ------------• -----•--•------------- ---- --------------------------- r FINAL INSPECTION S Date.---- ----------- ---- — - ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Americbn Street 300 West Oat; Sfreet 132 Sycamore Sfreef 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 ATw000 12-s4