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APPLICATION FOR SANITATION PERMIT Permit No. --33 ( f (Complete in Duplicate) a.� ..�_ .� , Date Issued ._-4- 1/ 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. I JOB ADDRESS AND ATIO ': za /U ' l Owner's _6;1— ----------------------- -----------------------------. ----------------=--- --- Phone----•---------------•--------------- Name ------- Address-. ` - } = Contractors ^Name -= ---•-•------ Phone--- Installation will serve: Residence 9, Apartment House ❑---Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ____ Number of bedrooms ___Z)Number of baths ___ Lot.size ___�r�.__ _. ____�d-------------------- Water Supply: 'Public system .k_ Community system Private ❑ Depth to'Wate'r Table A97it. Character of soil to a depth of 3 feet: ' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe[&' Hardpan ❑ Previous Application Made: Yes ❑ No:[J New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; j (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-/ _=Distance from foundation____/D_..______.Material_ o. of comp .__------- lbw. Nartments'__.__.-cV-_.____ .__-Size____ x �� Liquid depth ---- ---Capacity--------g' -e Disposal Field: Distance from nearest well--1 !Ma.C-Distance from foundation.____ .____.Distance to nearest lot line___a4?___.._ ' [$[ Number of.lines------------l//__--.__.-- Length of each line------� i___'Width of trench Type of filter material----__ __s-_..c_E�epth of filter material___________________ Total length____. �, � -_ ""_--__--___-- rem founda ion___. -� .__.Distance to nearest Number of its____ ______________Linin material_._ jB " Seepage Pit: Distance to nearest well___.__ p r __ �-4Distance f______ �� Diameter_=__.- ' !� -------Depth Cesspool: Distance from nearest well_____ _________Distance from foundation_;_------------------Lining material____.___`'�--'�____-{__.______ ❑ Size: Diameter------_ __:_ ------------ -----------Depth---------------------'----------------- ------------Liquid Capacity--1 Privy:, Distance from nearest well _______________________________________ _Distance from nearest building---- ❑ ::" Distance to'nea�est lot line----------------------------" - - -- 9 Remodeling and/or repairing (describe)--------------------- ••------ --- •------ r -------•-=--------------------------- ----^--------------- -----------+----------•----=------ ..------ ----- E 3 ,I----- ------ �----------------_------------- ----------------------- ��------- �. - - -- , I hereby ce that I have prepared +his application and that the work will be done in accordance with San,Joaquin County ordinances, St Oa s, and rules and regulations of +he San Joaquin Local Health District, 4 . . (Signed) -�---r- -----•-------=-•-----------•----- ------------------------------p ner and/or Contcactorl By. ---------- - ------------ --------=--------------------- ------(Title)--- --------------------------------------------- (Plo+ plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ---- ------------------------------------------------------- DATE----- REVIEWED BY----------------------------------------- ------ ---------- ------- --------------------------------- DATE------ -----� -------------------- BUILDING PERMIT ISSUED-------------------------------------- -------- DATE---------------- Alterations and/or recommendations--------------- :-------- •- ---------------------------------------------- ------------------------- k��_, -------------•-------•---------•----------- I ---------- ------------------------------------------------ ---- ---- ----------------------•------------- ----------------•------------- •-----------•--------------••-------------------------------------- k FINAL INSPECTION BY:. .___ -- - ------------ •-= Date------- ----=--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes* Oak Sheet 132 Sycamore Sfree+ 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES--•9-2M Revised W-2100