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W � . APPLICATION FOR SANITATION PERMIT Permit No. 3_.�_ - -------- lit {Complete in Duplicate)� Data �`Issued T 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. J JOB ADDRESS AND LOCAT,I :�. - A�- Owner's Name-------------------- F , �p----------------------------------------------------- Phone-------------------------------•--- l --- ,.L ------ -- � - C:�`�"'"�- --------- ------------------------------ -- --------------- hone- -- -- hone_ J ------ Contractor's Name--------.--- . -•-- - -- --R--4.6-- ----- er Installation will serve: Residence Apartment House E] Commercial F] Trailer Court ❑ Mot ❑ �h _� Number of living units: _ er of bedroomd/-r/ " ___ s ____ Number of baths ____ Lot size _______ _ G 5 Water Supply: Public system Community system ❑ -Private ❑ Depth to Water Table./ft. �� f Character of soil to'a depth of 3 feet: Sand ravel E] Sandy Loam lay Loam El Clay E] Adobe Hardpan El Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic,fank or cesspool permitted ifApuub`liXe is available within 200 feet. VE GY tance fr m foundation_ Mat ------ Sepr� tic Ta Distance from nearest w I "" �___- S' Liquid de th______ _____ ___ Capacity � --- �J r� No. of compartments-- ----A-----�- `,�``,�� {-�`1- Fr,?�. .---- q depth-----,. p Y Disposal F' d Distance from nearest welllY_ �'V___- istance from foundatio4-ib- ------- ___'Distance to nearest lot�ine___SrNumber of lines-------- --------- -- ength of each line"_ -.Width of trench___-- --------- ��Type of filter material-�__ LC-6epth of filter material___ _____--_-___Total length__________ _____________________________ Seepage Pit: Distance to nearest well______--____________Distance from found ation--------------------Distance to nearest lot line-_______________ ❑ ' t t Number of pits-_------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- !' a, Cesspool:., . Distance from nearest well-----------------Distance from foundation----------------____Lining material---------------------------- ❑ Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------=--- 9a s. Privy: Distance from nearest welL------------------------------------------------Distance-from nearest-building__ -----_________________-_---- _-------- ; 4 ❑ Distance to nearest lot line--------- ----------------- .. g Y-- ------------------ Remodelin and/or repairing {describe)__________________ -- ----- --------------- -- ----------------------------------------------------------------------- ----- ------- ----- -------------------------------------------------------------------- - Ir I I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a regulatio s of the Sa Joaquin Local He lth District.o ' {Signed}-------- - ----- ---- - (Ow and/o ontractor) ' BY:----------_-- ----- r e-------------------------------------------------------------------(Title_):-- - - - ---- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR-DE ARTMENT USE ONLY APPLICATION ACCEPTED BY---- -- - -- . .'= fit f e7 d ------------ DATE------ ----!--------------------- REVIEWEDBY----------------------- ------------------------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------- ------------ -------------- DATE------------------------------------------------------------- f ---- --------------- -•------------------------------- ` aerations and/or recommendations:---- -- ---------------- -------------- ------------------------------------------------ ••--------•-•---- AI - - __ ______._______ ____ ----------- -------------- - --- ---------------------------------- FINAL INSPECTION BY:-"" !F p ------------------ Date---------- j a---------------------,----------------------- ��__�"��---� 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 ES-4-2M 8-51 Revised W-2100 r