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APPLICATION FOR SANITATION PERMIT Permit No. .__...7.Z>-5 (Comp(Complete lete 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 Count Ordinance No. 549. o -- .......... .�----------------------- - Y JOB ADDRESS AND L TION______.__ _ -- - - Owner's Name.------ ;ro- Phone Address-----------•- c'��.-------�J -----------------------------------•--------------------------•----------------------------- - F Contractor's Name �- -t Phone---------------- ------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _. _. Number of bedrooms —0--Number of baths __/___ Lot size ........i;7✓` ____1�__� v_________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _�,�_At. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Ciay ❑ Adobe EL Hardpan ❑ Previous Application Made: Yes ❑ No W New Construction: Yes ❑ No ®. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_ on-K -Distancee�frrom foundation_-.__ _______.Mater+aL._�i__�°_�__.______________-_ __ ___._-.. i No. of compartmems_..__ --------------Size- --x-- 6a-Liquid depth------&.43---------.Capacity_•-1�---------- Disposal Field: Distance from nearest weli._,l A,---Distance from foundaticn_,X(_F.,_`----Distance to nearest lot line----- Number of lines---------- ----- rr _Length of each line__------- `Zl -.- Width of trench.......;,wz_,9 ------------ Type of filter material-_�_9.._----5-,RDepth of filter material_/4..._----._Total length____youd�J-------------------------- Seepage Pit: Distance to nearest well---A 6_ Distance from foundation___�a_f._..Distance to nearest lot .Q Number of pits-_____l-------------Lining material__- Diameter__.__31-----------Depth-----tea I Cesspool: D+stance from nearest well--------------___Distance from foundation_-------------------Lining material------------------------------_______. ❑ Size: Diameter------------------------- ----------Depth- ---------------------------------------------- ---Liquid Capacity- --------------------------gals. Privy: Distance from nearest well------------,- ------------------- --------------Distance from nearest'building____.____.__._____:___________._---___.._. ❑ Distance to nearest lot line- - ------------------------------------------------------------------- -------------- -------------------------------------------------'---- 4 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, Stat a , and rules and regulations of the San Joaquin Local Health District. R _ (Signed) --- ------------------------------------------------ ------[ wner and/or Contractor} By:..... • ----- --- ----y [Title} (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------- ------ ---- ------ ------------ a------------------------------------------------- DATE---------- ------_.--------- --------------------------- REVIEWEDBY--------------------------------- ----------- ------ ----------------------------------------------------- DATE BUILDING PERMIT ISSUED.--------- -- ------ DATE... ----------------------- Alterations and/or recommendations:------ --------------------- --•----------------•-••--------- ---------- __r 1____.,'_______'^-...----- ___..�__ _.__-.1___ ____.�_____�..�_5------------ -------__________ -------------------------------------------------- _______------------____ _________•-----______-- ----------- --- z .. - '--- ----------------------------------------- - ----------------------------- --------- ------------ ----------------------•------------------------------------------- \ -------------------- - ----------•-----------------------------------•• ------•:_.:. -------------------------- ----------------�------ - - ------ -----...---- •---------------•--- ----------- �i �T - 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 r9-9-2M 14s44S nTw000 12-54