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r qq•. ' APPLICATION FOR SANITATION PERMIT Permit No. S_q,!-.___ r (Complete in Duplicate) Date Issued ___ 1'-"- 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION ' t�".-.._.! " G�----------------------- ----------------------------------•-------•-------•------------------- Owner's Name_-------------------- ----- -------- -•--------------------- ---- ---------------- Phone-- Address................................ .... -------- Contractor's Name------------------- - S_--- --- - -------- - ------ -- --------- - - -------- ---- rte.. Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....{__ Number of bedrooms ---3. Number of baths ____)__ Lot size ----------____� _ -2- 5 Water Supply: Public systemommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g—Herdpan ❑ Previous Application Made: Yes Eg_-H'o❑ New Construction: Yes o ❑ v TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewe is available within 200 feet.) _ t Septic Tank: Distance from nearest well___ ante from fo ndation-----JP--------Matrial__e/ _____ fir -- No. of compartments....----__- _.__Size___s "' .7--Liquid uid de th...__- Q...___------Ca acit _C A. q p. p Y .......•. Disposal Field: Distance from nearest weft.. . _. _ istance from foundation____.___ ..._ P ._____.Distance to nearest lot line,_________. RZ Number of lines-----------------'�s..--------.-Length of each line___ — � g -.C- _ --L�.Width of trench-------�-�- ------------ Type of filter mate rial___....e_<_Depth of filter material___.. __4 ---Total length-- 7 _�---------------- See ge Pit: Distance to nearest well._ -_. . _Distance from fou dation-_-_ -!_---.Di tante to nearest lot line------ Number of pits---......../_.-------Lining material_ �GC..Size:�-Diameter.__._. _�--_--Depth---------T_-- -<--- :_ O Cesspool: Distance from nearest well----------------- from foundation_____--------------Lining material__..__-____-_._____._.___--__.______ ❑ Size: Diameter------------------------------------ Depth-------------- ------------- ------....------ -----Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------------------------------------------Distance from nearest building------------------------------ -----------. ❑ Distance to nearest lot 1irie--------------------------------------------- - -•---•-------------------------------------•-------------------------------------------------- Remodel' and/or repairing (describe):-----,. 5; --------- ------------------- ------------ ----------- ----- - -- - - -------------------------------- I hereby certifyth have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------------- - -- - -------------------------------------------._._.Owner and/or Contractor) - - ---- ------ ----By: -� ---IT+ie)------------ --------------- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--- ----------- --- ---- ---- --------------------------------------•-- ------ DATE------ --5--—------------------------- ----------------- REVIEWEDBY------------------------------------• --- --- ------ -- ----------------- --------------------------------------------- DATE---- - -- BUILDING PERMIT ISSUED--------------------------------------- -- --- ------------ ------------------------------------- DATE-------------------- Alterations and/or recommendations:________________________ _ - -------------- - .� -------------------- --------------------- -------------- -- --------------------- -------•------------- ---------- --------- -� -------------•-----------------------• ------------------------------•----------•-------------------------- ------------------------------ --------------•----------•- ---------- - -----------------------•----------------------------- -------------------------------------------------------------- e FINAL INSPECTION BY:---- - `5 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 E."-.--3 14544b ATWDIID