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APPLICATION FOR SANITATION PERMIT Permit No. .... ..........1_- (Complete in Duplicate) �I f Date Issued .._ t _ Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descri. , This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------' �� -�.--- ... --------------------J -— ----------N----- ,-•- �o� p Owner's Name---------------------------------- F � '�..7•a�-------`��_Phone---------------------------- Address------------------------------•----- k• ,O_C?----- - -- -----------------------------••---• •-----• -----••----• Contractor's Name--------------------------------------------------- 4 ---..-------r?-�. '- ------------------------------ Phone----•----------------------- .:. Installation will serve: Residence JEJ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: _1.__- Number of bedrooms ..1... Number of baths J... Lot size ------ kS—X-.l--------------- - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. i to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam ❑ Clay ❑ Adobe � Hardpa > ' Character of sol p ❑ ❑ Y ❑ Y f Previous Application Made: Yes, No ❑ New Construction-. Yes ❑ No ,& { TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well". - -------Distance from foundation____/�2---------Material---_--_---------------- ------------------ No. of compartments......... ----------Size---32K,6'c_11----Liquid depth----------- ..-.--.----Capacity------- ": _ •..• a Disposal Field: Distance from nearest well_.`-'...___-Distance from foundation--..-/_ _._...Distance to nearest lot line..-.._^ Number of lines--------------------------Length of each line----------�c1-..........Width of trench------------ Type or filter material.. Depth of filter material.__..-4�--------Total length------- -----------------------.._.._:,:: Seepage Pit: Distance to nearest well ---------- of its---------------- -- Linin material-----------------------Size: Diameter-------•----------.---.Depth---.------..------------------- .-....._Distance from foundation_............._.Distance to nearest of ine......."._.__... ❑ p� -- g --Y . 4 Cesspool: Distance from nearest well-----------------Distance4rom foundation--_----------------Lining material--.,----------------------.- ❑ Size: Diameter--------------------------- --- ------Depth--------------------.-------------- ----------------Liquid Capacity- --------------------------gals. - �` '= Privy: Distance from nearest well___________________ �---_ -Distance from nearest building ❑ Distance to nearest lot line------------------------- ------------------- ------------------------------------------------------------------------------------- Remodeling and/or repairing (describe= � — . ?+4-- •..P_h. .. -- _ -------------------------••-----:-------------- V)i ,,r ...---•----.....---•--•-----------------------•---------------------------------- - ---------------•-------••-------------.---•----------------•--•----------------------------------- ------------------------ ----------------------•------------•--------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin`LocalrHealth District. .' (Signed)- `-p-- (Owner and/or Contractor) B ------------------------- ----------------- - --------------------�-----------� ---------------..(Title)-------------------------"----------------- - ---------------- (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 1 �' ---------------- REVIEWED BY = fl - ---------- ------ DATE BUILDINGPERMIT ISSUED----------------------------------- ----- ------------------------, -`----------------------=------. DATE----------- ---•----------- --------------------------------- -- Alterations and/or recommend ions----------- ----------------- --- -------- ----•----- --c.J--•--- --- �` ---------- 1 - --------------------------------------- ----------- ---------------------------- ------------------------------- ------------------------ ENSPECTiON BY:. --------- ----------- ---- ---- - --- I i� . � ` �- � FINAL - ----------- Dete------------------------------------------------ ----------------- ------ ------------------------- 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 145446 ATWOOD