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APPLICATION FOR SANITATION PERMIT �, Permit No. .Ca.............. (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. JOB ADDRESS AND LOCATION--- _.a -------9f...... ............ ---------- Owner's Name___ a -�._. __ _ --_- Phone._ L .: 7-.!..__...17 Address . ,. .. f- ' ---------------------------------------------------••------------------- ................................................ r Contractor's Name r' ----------------------- ----------------------- Phone � .b� ' Installation will serve: Residence gl--4artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l___ Number of bedrooms _- Number of baths --/_- Lot size __.'S7A----A------ .S_0---------------------- Water Supply: Public system A—Community system ❑ Private ❑ Depth to Water Table, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No A"New Construction. Yes 4 -Nlcr� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic'Tank: — Distance from nearest from foundation--.-_� Material---- -----------_'------------ No. - ------• No. of compartments._._._.. ._______.__Size__ �x_ _ ------- -----------Liquid ciepth__.- _ �-`___._Capacity___ r�._.___.. Disposal Field: Distance from nearest well----Distance from foundation----1-p-_'----Distance to nearest lot line---/--O-- Number' of lines------ ._-- _--._.__Length of eachline--- - --------��-._.Width of trench---- :�- - --------------- Type or filter material-----.�--------------Depth of filter material _.1 ..........Total length--------3-0--------------------------- _ Seepage Pit: . Distance to nearest well�'j?.N`-t_____Distance mfouf'datton----�d--- istance to nearest lot line-__- [ � Number of pits.---._/..--........Lining material-- _. _.Size: Diameter---3-3-----------Depth------ _--_-_:--------- s Cesspool: Distance from nearest well________ _____Distance from foundation----------------------Lining material-----------.-----.-.-_--------_-_--._. v ❑ Size: Diameter ----------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Priv Distance from nearest well____-.'-------- ----------------------------------Distance from nearest buildin Y9' ' ' ❑ -Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or, repairing des(fribe]:-------------------..... ---------------------------------------------------•---------•------------•--•------=-•------------------•---------•------------------------------------------ ------------------•------------------------------------------- ------------------------ ..-------------------------------------------------------p._ - 11 1 hereby certify that l have prepared this.application and that the work will be done in accordance with San Joaquin County ordinances,jStla s, and rules and regulations of the San Joaquin Local Health District. 5ined --- -- ------'--------- ------------------------------------ --- --( 9 ) --- --•••-. � --- " ) --=------ -------- (Plot ------ - (Title)_��_ a_ - --------------------- By: (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can 6e placed on reverse side). - FOR DEPARTMENT USE ONLY r APPLICATIONACCEPTED BY------------------- . --'--' --------------------------------------------------------- D E------ .... --------- --------------------------- REVIEWEDBY---------------------------------------------' ----------------------------------------------- - - DAT --- BUILDING PERMIT ISSUED------------- ------ --- ---------------------------------------------------- DATE..---------- --- - --------- ------------------------------ Alterations and/or recommendations:--------------- ---------- -- -- ---------------------•-•-----------•---------------•-•-----•-•-------------------- ----------•- '----------------- ----------- --•---•-•-•---•••--•---------------------•----------------- ---------------------------------••-•----------------------------------•----•--._...---.... ----------.--=--------------- . ------------------------------------------------------------------------ -------- ----- ----------- ---------------•---------'-•--------------------------------------------------------------------- •------- -.---' --------------------------- ---- ' --------•----------- --------------------------------------------------------------------------• ------ ----------------------------------------------------- FINAL INSPECTION BY::.----- ------------------------------ Date--------------\-----------------------------J------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 614 North "C' Street Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M 145446 ATWUUD 12-54