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APPLICATION 'FOR SANITATION PERMIT Permit No. V ` (Complete in Duplicate) V767,Date Issued ---<.-.J._. - 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 o. 549. JOB ADDRESS AND L AT ON... r ------ `�' Owner's Name---------- ----` ---- --- - --- ------------- ------------- --- ------- ------------ --------------- Phone.---------------------------------- Addresst�� ------- - -------- -------- om------------ ---=--------------------------•-........-. -.-----------------•------- Contractor's Name � �L ... ------ Phone _ --� Installation will server Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: . .._... Number of bedrooms -.-�} Number of baths ---- Lot size ._--. cx.� _-----.__„---- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table . .6 ft. ” Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ Nox New Construction: Yes Pr No ❑. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic Tank: % D' tante from nearest well-----------------Distance from foundation--------------------Material------------------------------ ❑ 0. compartments..... Size Liquid depth--------------------------Capacity --- ------------ Dispos Field': D' tante from nearest well.................Distance from foundation---------...------ Distance to nearest lot line-.-. _....----- ❑ um er of lines-----------------------------------Length of each line-------------------------------Width of-trench---------•------------------- =•-., T e or filter material-------------------------Depth of filter material...-........_,.__W_-._-Total length-..--..--_.------------_-----..........J " Seepage Pit: Distance to nearest.well..(`-zBistance ro founds io -.-. ..-...Distance to nearest lot line... ��f f . Number of its.___- -- _.--------..Linin material V<iameter___.- `! p _--- - p / g o - Depth Cesspool: Distance from nearest.wLll-----------------Distance from foundation---------------------Lining material-------------------...__-----.-------- ❑ Size: Diameter------------------------------- -----Depth----•--------- I------------ ---- ----------------Liquid Capacity..--------------------------gals. (�\ Privy: Distance from nearest well................................... .............Distance from nearest building------------------------.---------------- ❑ Distance to nearest-lot line- --------------•--------------- ----------------------------- •-�--------- Remodeling and/or repairing (describe): F --- ----------•---•----- --------- -------------------------------------------- •--- ----- --------------------•---------• ----------------------..-..--------------------------------------------------------------••---•---•--------------------------------------•-------••------------------..- '-"----'-'--'-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin-Cou!1fy ordinances, Sta aws and rules and regulations of the San Joaquin Local Health District. i ---------- ------------- (Signed)---- -•---- -..--- - -- 1 f --------------(Owner and/or Contractor) BY: T - - f ---- •-- ------------(rfle)------ -..c--------------------- ---------- --- (Plot plan, showing size of lot, 1ocafion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- -----------•----------------------------------- DATE--- p; REVIEWED BY------------------------------ --- ------------------ ---------------------------------- DATE__- = `r BUILDING PERMIT ISSUED----------------- -------------------- ------------------------------------------------ ------------- DATE------------------------------�_. { Alterations and/or recommendations:- '-------- ------------------------------------------------------ •---•------------------------------------------••--------•-------------------------` K ............---------------------------------------------..........................................................................................-.-...............-.--__...---.---.......-.-._-.-.------------.------------- ....................................................--------....---...-..........._.....__...__.._...----------.------ FINAL INSPECTION BY:.'-'-- - p *r---` -=-�- --='`'� . Date--- l-_ + r 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 745446 ATWOCD