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APPLICATION FOR SANITATION PERMIT Permit No. s;7— (Complete in Duplicate) Date Issued Applica-'ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Herein des "ibe6. This application is made in compliance with County Ordinance No. 549, y t ' #. JOB ADDRESS AND LOCATION_ --s- --- ----- 5`-dam ,t ----r - - �i Owner's '-["�=-��--��------------- -" • -------------•-------- ----- - -- - ----- ------- ------- Phone_ ----------------- •�-�' Address ------ --- /Contractors Name------�P�_�KL't�_��f------_��,eSLCN �- ---• 1 -------------------------------`Phnom--•------------- Installation will serve: Residence VAparfment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms - Number of baths __/___ Lot size Water Supply: Public system ❑ Community system ❑ Private ®-"D-epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑. Gravel ❑ Sandy Loam (Clay Loam ❑ Clay ❑ Adobe❑ Hardpan [] �+ Previous Application Made: Yes ❑ No 2 New Construction: Yes ❑ No 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________________Distance from foundation----.--------------.Material------------- F1 __________--❑ No. of compartmen.ts--------------------------Size----••--------------------------Liquid dept.h----------- --------------Capacity................. Disposal Field: Distance from nearest well-----------------Distance from foundation--------- -----------Distance to nearest lot line___________ Number of lines- r ' - �_Z/ ------------ -----Length of each line-------f.Q�-----•----.Width of trench----=-- `--- ------- --- Type of filter materiaLRQ,G-k----_____Depth of filter material-----/ ------------Total length----------104,--.______ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line___________.:-_ k,+ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------------------------i Cesspool: Distance from nearest well----------------Distance from foundation-------------------.Lining material_:____ ❑ Size: Diameter = --------------------------Depth---------------------------------- ----------------Liquid Capacity Privy: Distance from nearest well ------------------___ Distance {nom nearest building----------------- g------------------------•------------r- ❑ Distance to nearest lot line----- - ------------------------------------------------------------------------ Remodeling --------------------------- Remodeling and/or repairing (describe): � - .-Q��,' ' ? ---------••--------- -•-----------•-----------------------•---------•-•-----------•------------------------------------------ --- . ----- -- -------•--------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)____ - -- ------- ---�rt�� J. •-----Iv _-c�/l.�. 1 - (Owner.and/or Contractor ( ) ------- ---- ---------- -----------•---------Title_ -��-�-s-'----- --•--------- ---- ----------- (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---- �---------�-R�-��;�-------------------•- REVIEWED BY ------------------------- - DATE BUILDINGPERMIT. ISSUED---••-••-----------------------------------------------:_-_--------------------------------------------- DATE_. Alterations and/or recommendations:: x_.._.:. ------=.. ----------=----=---=-=------.........•-=__.:.--------._-, ••-----. -- :. -------------------------------------------------------------------- -------------- -------------- --•------- --•- ----------------------------------------------- ----------_------______----------------------__----------------------------------_-----------_-------------------- - ----------------------_------------------------------------__________________________•_____..___..__._._____.__._____-_______._____- -FINAL INSPECTION BY:," -* n -------------- Date.-- J-_.-- I------------------------------------------------ SAN ------•-----------------•-•---- 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 E5-4-2M ; Revisad'W-2100 _,_/