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APPLICATION FOR SANITATION PERMIT Permit No. .- (Complete in Duplicate) y Date Issued ___/ r_3 Applica$ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wok herein described. This application is made in cQmpliance with County Ordinance No. 549. `�3& F- 40 JOB ADDRESS A D LOCATION----------- _ Owner's Name----- .0.�±�L Q _---------- 5 -- Qv`s - fyy1._. 1 .. Phone ------------_----- Address------------- Contractor's Name 1! •- h <-`^ "ti_ c ,�,� Phone - "7-0—Y Installation will serve: Residence partment House ❑ Commercial ❑ Trailer CourtT Motel Ot he Number of living units: _1____ Number of bedrooms __.I"umber of baths J---- Lot size ...._- LD— Wafer Supply; Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob aQD_.-Hardpan ❑ Previous Application Made: Yes B_19 ❑ New Construction: Yes ❑ 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 -4(--Distance from founcla ion_ - �- --f.__ Mater, 1_ No. of compartments---------------------------Size-- _ r_-_ _ Liquid depth---___- - - -------CapacitY Disposal Field: Distance from nearest well-A&P, Distance from foundation _Distance to nearest lot line_,__:!!7-, W Number of lines--------/------------------------Length of each line___,5_ _Q !------••----.Width of trench-- ;2 t__``!__-_- Type of filter material_ (.,.P,V_w----Depth of filter material......_ len g _Tota! th---•--------�-C?----------------------- Seepage Pit: Distance to nearest well-y! ------Distance from f undation___..� _--f__._.Distan ce to nearest lot line__ 11----------- - Number of pits..------r_--______.Lining materialr_ `_ _.Size: Diameter---3�-" D ---_ "-_- __-- ep -_-_____I -Cesspool: <' ( ' th y Distance from nearest well-----------------Distance from foundation----------_-__"-"_-.Lining❑ material__..__.__._------------------------- Size: Diameter--- --------- �---------- �-----.Depth------------------------------------ ----- - ------Liquid Capacity......------------- Privy: Distance from nearest well...... ---------gals. ............. .............................Distance from nearest buildin Distance to nearest lot line_____________________ ___ g ------------------------- Remodeling and/or repairing (describe)__________________ -----•------------ ------------------------------------------•------•---••- ----------------------------•-------•------•------------------------• ------- ------•---------------------------------------•------•-----------"--------------------------------------•---- ------•--------------- -------------------•-------------------- ---------•------•--•-------•----------•---------•- . - ------------•------•-------- --------•----I-------------------•-------------- at the work will be done in accordance with San J I hereby certify that I have prepared this application and thoaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---••---------� -----------=------------------ --- caner and/orContractor) (Title)- [Plot plan, showing size of 10 , location of system in relation to wells, buildings, etc., can be piece on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ' ) 4— ------ DATE REVIEWED BY ------------- -- --------- - ---- ----- - • ------ DATE-------- ------ ` BUILDING PERMIT ISSUED----------------------------------- - ------- ---------- ------------------------------- -------- --------- DATE------------------------------------------------------------ Alterations and/or recommendations______________ -- ----- - ---- ------------------------ - ------------ - FINAL INSPECTION BY:.. ---- -------•------ ---------- Date-.-,. --/------------- - S --- ----- --------------- 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-5 345446 ATWC00 s