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/- X014 G '` APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued _______//__�{_� 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 [x%549. JOB ADDRESS AO LOCATION - _ ------- c .. - Owner's Name... ---------------- Phone-------------------------------•-•-- :'!--- - - -7t Address......, r---------�---------- ---- ------------------------------------------------------------------------ - ------------..--------- Contractor's Name---- ----- t Phone - p J Installation will serve: Residence 23— artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�____ Number of bedrooms--T- Number of baths 2�_ Lot size ---- ts. _--_______________________ , Water Supply: Public system ❑ Community system ❑ Private gf—Depth to Water Table -/Fft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 9--New Construction: Yes ❑ No E! _ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) j Septic T nk: Distance from nearest well------------------Distance from foundation--------------------Material-----_-_-__-_______._._----._-----_.._---------. �{ No. of compartments----------------------- -----------------Liquid depth---------------- ------- Capacity. Size_______________ .Ca acit ff ...._. sposal Field: Distance from nearest well-_ �_-_Distance from foundation___,__-r_ _ ` Distance to nearest lot line.._/- _---. Number of lines--------- --------Length of each line------/.2_47" ------Width of trench.-7W-__ _-.---___.-- V Type or filter material._ _�,_.___-._.__Depth of filter material_._./._ _---.Total length---._--�..�..�___________________ O Seepage Pit: Distance to nearest well----------------------Distance from,foundation-----_-------_--_...Distance to nearest lot line..-_--..---_----_ —' ❑ Number of pits-------------_ -----Lining material.-•-------------------.Size: Diameter-----------------------Depth---....-------------------------- Cesspool: Distance from nearest well----------------- from founclation ------------ material--------.._________.____-.---------. 1 ❑ Size: Diameter2=---------------------------------Depth--------------------------------- - --------- ------Liquid Capacity----------------------------gals.� Privy: Distance from nearest well-__.-..__.___.._.____________________________Distance from nearest building.___-._--.-_.------------.--------------- Distance to nearest lot 1ine-------- --------------------- � -- -- - ------------------------------------ ------- --------------------------------------------- r , Remodeling and/or repairing Idescribe)---------------------------------------------------------------------- ----•----------------------••-------- --------------------------•-----------•--•-- ---------------------------------- --•--------------------•-----•----------------------------------------------•-•-•--------------------------------------------•••----•------------------------------------- -------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sate laws, and rules and regulations o +he San Joaquin Local Health District. R (Signed)--- - -----"- -------{8wner-enJd or Contractor) - • /6� .,t -- --------- „"�„? - �+-.'..."" - ----------------- ---- -•----- -Title -- -------------------- --------- -- (Plot plan, showing size of lot, location of system in..relafion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE -- •---------------------------- g REVIEWEDBY-------------------------------------------- - ------ ------------- ------- -------•------ ------------------------ -- ----- DATE-------- -- BUILDING PERMIT ISSUED DATE ---------------------------------------- Alterations ----------------- - Alterations and/or recommendations:------------------ ------------------------------------•--•-•--•--•------------•------------••---.---- \ ...........I._.......---•------..__..�... --•--....----•-----•-•------•--......--••--••............................................ ........................... f ---------------------- ----------------------------------------------------------------------------------------------------------------•-----------------------------------`--- _...-------_•................•--------....------..._.--.------ --------- - -- ----------, -._...-------------------....------------------------------------------------------------• FINAL INSPECTION BY:------ , ------------------------------ -------------- Date------.....40--'----L-6---- ---.~3 ---•------------------ 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 E5-9-2M 145446 ATWOOP 12-54 J