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APPLICATION FOR SANITATION PERMIT Permit No. ___.G-.`�_ .._-__ rYr � (Complete in Duplicate) Date Issued Applica4-ion is hereby made to the San Joa inLfgaDi t ic+for a permit to construct and install the work herein described. This application is made in compliance with u r n nce S44. - `---'�---------------` -`------ h -------•-------- --•--••_-------------_•---- JOB ADDRESS AND LOCATION-- pPhone------------------------•---------- Owner s Name--- --•---•- --------- Address----- S: ------------------------- ------------ --- � Phone-lI Contractor's Name------- --•---• -----------------------------------•--------------- -... Installation will serve: Residence [ - Apartment House ❑ Commercial ❑ Trailer Court ❑ Mofel,❑ Other ❑ Number of living units: --/---- Number of bedrooms _--->_. Number of baths --I--_ Lot size _--- __ _-. t-.•-l_7/------------------------ Water Supply: Public system q Community system ❑ Private ❑ Depth to Water Table -------- ft. Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9 Hardpan ❑ Previous Application Made: Yes ❑ No E21 New Construction: Yes ❑ No 2k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic A ,or cesspool permitted if public sewer is available within 200 feet.) -----------Distance from foundation_-.-._------....---.Material------.-__-;------------.----------------------- Septic Tan ist ce from nearest well-- ❑ Na of compartments------ -- -- ---Size---------------------•--------• Liquid depth Capacity Disposal Field: Distance from nearest weld__/4/ _Distance from foundation_--3 -__-----.Distance to nearest lot line--------------j_ Number of.lines-.-.------_-�.'..--- - ength of each line-----_---�Q-----f'------Width of trench--__.�.�___-------____------ 0 r L---- -- Type or filter material---- � ------S- -1Depth of filter matenal__---- -------.-Total length--_-_--�Q----_--_-__---_--- .__-- _/�-- R� Seepage Pit istance to nearest well-----t 6' __Distance from foundation--x__10----------.Distance to nearest lot IineF--: _ --- / g iie: Diameter -` - ----De to---- ---- 1 Number of pits--------- ------------Linin material--�r_�_._.--�- -- - - - P - -- ---- G 14 Cesspool: Distance from nearest well-----------------Distance from foundation--------_-_-------- Lining material----------------------------__----_- ❑ Size: Diameter-------------------------------------Depth-----------------------•------- --------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------_----------------------------- -Distance from nearest building------------------------------------------ El .----.-------___--_-_-----------------.❑ Distance to nearest lot line--------------------------------------------- ---------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------- - ----- --- -- ; ........ c ,� _-- ----•----- - - -- ---- --------- ------- - ------ --- - -- - - - -- ----- -- -------------------------------- I hereby certify that I have prepared this application and that the work rill be done in accordance with San Joaquin County ordinances, State la . and rules and regulations of the San Joaquin Local Health District. -----------:e------------------- ------------------_(Owner and/or Contractor) (Signed} -------- -------•------ --- /� � 1 z �-'�z��_:► ------------------------------------ ----------------- '----------------------------------------(Title)----•----�-��-Yl� -------------- - ---------------- (Plot 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---------i- ------.--------------- ----------------- - ----------------------------- REVIEWED BY - -------------------------------------- DATE = BUILDING PERMIT ISSUED------------_--- DATE -- - --------------------------------------------------------------------- - Alterations and/or recommendations:------- ---- --- ----c ------------ -------V------------------- ----- -- -------------------- -------- ------- ---------------------•------------------- ---------------•---------- ---------------------------------------------------------------------------------------------------------------------- -------- ------------ -------------------------------------------- ----------------- ----- -------------------------------I------------- Y� �� - ------------- Date---- -----7`rr-------`�--- FINAL INSPECTION BY:-:-_-_ ----------.- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C' Street Stockton, California - Lodi, California Manteca, California Tracy, California ES-9-2m 145446 ATWSOP 12-54