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F APPLICATION FOR SANITATION PERMIT Permit No. ...A--S____!_ (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 No. 549. 16 JOB ADDRESS AND LOCATION----- X4_4 ----------------------------- 'Owner's Name------4 _%-------Q 8 .. Phone--- •------•------------ - ----- - ------------------------------------- - -------- Address------------ Contractor's Name--- ---•--•-------•---••----------------------------------------------------------------•---------------. _ Phone--------------- --------------- Installation will serve: Residence] Apartment House ❑ Commercial ❑ Trailer Court C-] �tMotel ❑ Other [-]Number of living units: i___F _I_ _ Number of bedrooms _ _. Number of baths ----- Lot size ____Q-_ ___ _-_ _©_____________________________ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table rp__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam); Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [] Previous Application Made: Yes ❑ No New Construction: YesJ} No ❑ - TYPE OF-INSTALLATION AND SPECIFICATIONS: T.-- (No septic tank or cesspool permitted if public sewer is available within 200 Septic Tank: Distance from nearesf•well_A.p.0-----Distance fro foundation9Ui - -`- ---_--Material---t��----------------------. No. of compartments �' ar�t?____-___Li a th_.._Y_..__._. _p �-- - ---------Size--------- -- ----- qP. - - ------Capacity--��Q"}�------- Disposal Field: Distance from nearest we11_X06_..._Distance from foundation_- - -----------Distance to nearest lot line-_- i�__.11------ Number of lines--------/__---- _ a ----- Length of each line-447 ---- ------------Width of trench-_��'----------------------- Type of filter material__�_�-_. ._ -Depth of filter material__ _�--------------Total length_6 ________.____________________._ S Seepage Pit: Distance to nearest well---------------_------Distance from foundation------------------..Distance to nearest lot line__.__-________._. , ❑ Number of pits----------------------lining material-----------------------Size: Diameter------------:----------Depth--------------------------------- 1 Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material__-.-_...__________--__._____________. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity-- ------------------- Privy. -----------------Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------.--------.-------_-. ❑ Distance to nearest lot fine---------------------------•--------------------------------------------•-----------•---------------------------------------------------- z_ Remodeling and/or repairing (describe):_ ..- --- - ---• ----------- �------�-- •... ------ 5 --- - -... w -----/� ------------------ •-• ir :-- ------ ---- - --- - --- --------------------------------------- ----------------------------- --- ----------------------------------------------------------•-------------------------------------- = ------ -------------------...---------------------.... --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules a d r gala 'ons o nth San Joaquin Local Health District. ,.(Signed) --- - - ------------ -,----- (Owner and/or Contractor) .. T SY= --------------(Title)------------------------------------------------- ------------ (Piot 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-- - --------------------------------- - -•---. DATE.---- �°--57 - - - - -- ---------------------------- REVIEWEDBY--------------------------------------------- --------------------- ------------------ -------------------------------------- DATE---- -•--------•------------------------------------------ BUILDING ----------------•-- ------------------ BUILDINGPERMIT ISSUED----------------------------------------- ----------------------------------------------------------- DATE----------- ---------•----- -------------------•------------- Alterationsand/or recommendations:_... -----------------=----------------- -----------------------------------------------------------...----------- ------------------------------------ -----------.---------------------------------------- -------•----------------------4----------------------------•-------------------.---------------------.-......--...---•-• -----------.-....__........................---- -----•------------------- ------------------------------------------------------------ - ---- ---------------------------------------------- ----- -------------------------------------------------------------------------- -----------------------------------------------------------------------------•----------------------------- •--------------------------•----------------------------- ---------------------------------•------------------ FINAL INSPECTION BY -.-----.-•-:-,--= ---------------••---- Date__ _ .- -_ .. ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Streef 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E9-9 145446 ATWono