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APPLICATION FOR SANITATION PERMIT Permit No. _.. _ _- (Complete in Duplicate) S Date Issued .............. K'Applica-lion 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----_--_; fl--------(J�e5`� •�. _ Owner's Name------- ------ --- ----- +`ter 4__ - ---- - Phone---------•---- Address----------------••-------- 1 .._.- A................. .. ` --.---___---------------------------- Contractor's Name. ` �-- .:L c `+'uC me---- � -y Installation will serve: Residence partment Ause ❑ Com ercial ❑ Trailer Court Motel��rr�� ❑ ❑ Other ❑ _. Number of living units:/---_-- Number of bedrooms ____Number of baths ---/--- Lot size ---------- Water Supply: Public system ❑ Community system ❑ Private p--Mpth to Water Table +A_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ]-- ardpan ❑ Previous Application Made: Yes Ei—No ❑ New Construction: Yes ZL--No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Seetic Tank: Distance from nearest well--:----_---_.-_-Distance from foundation-------------------Material -_______....-___________-__-_.__..__. Fid No. of compartments ------- ------- ---Size Liquid depth.--------------------.----Capacity Disposal Fie d: Distance from nearest we '---`-.-Distance from foundation__+ U i------•Distance to nearest lot line.__��_.�__�_ fo- Number of lines-------�_- ' -- - --...-_. _ Length of each line______._..____ Width of trench------�`I----_- . - --------- Type of filter material____-._' ..Depth of filter material_,1_E �'------ Total length__..__�S _-_---------------------- Seepage --__ ��/ --------•- Seepage Pit: Distance to nearest welY_�' -----------Distance from foundation--/42-_-------.Distance to nearest lot line___"_._ WNumber of pits.--.--e------------Lining material Fr��_L, __ _Size: Diameter----- --------- Depth Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material-_--__.____-___-.__.________- El Size: Diameter------ -------------------------------Depth---------------------------- ----------•-Liquid Capacity----------------------------gals. Privy: Distance from nearest well---.._.-_____-_-__.__..- Distance from nearest building ❑ Distance to nearest lot _---_____--_._._-_____-__-- 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, St and rule bo frNFI-GLIOTTS of the San Joaquin Local Health District. Septic Tank Service (Signed) i 20frSa:Hdr►rado }Ip 2�fi0ts =' -•------- --- caner and or tractor) BY: .---------= ---------------Stockfant Calif.- .�Tatle)-- ---- {Plot plan, showing size of lot, location of system in relation to wells uildings, etc., can be placed on reverse side}.�� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ DATE---------�------------------------------------------ REVIEWEDBY--------------------------------------------- - -------- -- --------------------- --------------------------------------- DATE BUILDING PERMIT ISSIDED---•---•------------------------------ - DATE D �,- ----'-- ----------------- Alterations and/or recomme tions__ __ _ -- -- - - ---- -- -- ------- ---- - -•---•--- ------------------------- - ------------------------------- ------------------------------------------ FINAL INSPECTION BY: ------------------ ----- ------ 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 ES-9-2M 145446 arw000 12-54