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APPLICATION FOR SANITATION,PERMIT Permit No. .__ I ,�(Complete in Duplicate) I y Date Issued -----/---- Applicalion 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 Ordinances No. 549. JOS ADDRESS AND LOCATION.... Owner's Name---- _-- -- -•____--S ----------•------------------•-• - ------- - --------------- Phone Q Y a------------------ Address -- ------- ---------------------------------•-----------•---- Contractor's Name------------......3____ ---------------------------------------------------------------------------------•---------------•------•--. Phone..--•----------••----------------• Installation will serve: Residence Apartment House Commercial ❑ Trailer•,Court ❑ Motel ❑ Other ❑ Number of living units: __ -_- Number of bedrooms __Number of baths -1_"_ Lot size ---- o Water Supply: Public.system ❑ Community system [] Private-b? Depth to Water TableG._ -_ ff. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adoba`� Hardpan ❑ Previous Application Made: Yes ❑ No New Construction- Yes ❑ No j� l ls TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan Distance from nearest well------.---.-_---Distance from foundation_--__----------._.Material------------------------------------------------- No. Lx� of compartments------------------------ f "'' _-Size-----•----------`--------------Liquid depth---------- --------------Capacity------------------------ Number ------------. Disposal Field: Distance from nearest well--__` .5=_-�.-Distance from foundation-1_0..."--__.__Distance to nearest lot lin.......Number of lines--------------- --- gth of each line------?��__-___•-- Width of trench--- _ Type of filter material- G r, Iter material--`-- �- ---------Total length------- ---•---•------- - Seepage Pit: Distance to nearest well-J--- _3f-----___Distance from foundation-_`_Q�_.. - Distance to nearest lot line-----�r-__-_, Number of pits-_.---_/-------------Lining material_0_Q_"R_rPdi amet e`; Di------ r.--_ —f Depth----- a esspool: Distance from nearest well-----------------Distance from foundation_....t------_---.Lining material----.--------_---------.__-_ ❑ Size: Diameter----=--------------- ----------------Depth--------------------------------- - ----------------Liquid Capacity- --------------------------gals, Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building ❑ 'Distance to nearast!lot line- ------------------ --------- Remodeling and/or repairing fdescr&b :-- �.__tr-.____� �+ _ ---•--------------------••-----•---------------------------------------------------- --------------------------•------------- ----------------------------------------- --- -- - .----- 1 -; -------------------------------•------ -•----•----•-- ordinances,hereby ytcertify iawsthat and I have nd r prepared this application San , .hat -------or •------------------e...i - accordance-- i --Sa q i County -- the•work will h done in with San Joaquin County ' quip Local Health District. � (Signed)------- _ _ ' F----- ------------{Owner and/or Contractor) By:----------------- ..' (Tale) -- ---------------------------------- ---- --------• ------- :_....------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-------- ------------ --- ------------ -------------- ---------------- ---•---•-------- ---..--._ ------------------------ --------- DATE-------- REVIEWED BY DATE_ - -----•---------•---------------------- BUILDING PERMIT ISSUED------------------'-------- -- ---- -- ---•----- - DATE------- ----- Alterations and/or recommendations--------------- ------------ -----••---------------------•------------ ------•------•-------- - ---•- ----------------••--------------•------- --------- V-----------•-----•-------- ----- ---------------------------•-------- ---- FINAL INSPECTION BY:----- Ln,.:k• _ ;� ' Dete-- ®` 1 a SAN JOAQUIN LOCAL HEALTH DISTRICT ` s 130 Soufh American Sheaf 300 West OaE Street 132 Sycamore Sties+ 814 North "C" Street Stockton, California Lodi, Galifornie Manfeea, California Tracy, California E5-9-2M 145446 AT-000 12-54 -