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(,\� n �Sko. APPLICATION FOR SANITATION PERMIT Permit (Complete'in 'Duplicate) g` Date Issued --- 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 Ordin ce o. 549. JOB ADDRESS AND LOCATION---------------- _/_ �` --_- ! Owner's Name . ------------ "r- '�i.J ------------------------------- Phone--------------- Address -----------•----•-•-------------------•- ------------------------------ Contractor's Name • ` �`� �`-� �1>J L _ ,'�6-1R �- ----------- Phone- _--- Installation will serve: Residence partment House ❑_ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms( /Number of baths ___ ___ Lot size ------------------------------- Water Supply: Public systemommunity system ❑Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay-Loam ❑ Clay ❑ Adobe Lj__Wer'dpan ❑ Previous Application Made: Yes ❑ New Construction: Yes 9--17o ❑ „ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet:) Septic T nk: Distance from nearest well-W�Ve__,Distance from foundation---IQ.� -_�-Material__�� -----_-.--, No. of compartments.....--__ -------Size-- - -'- -------Liquid depth----(�--f7. ----------Capacity___ �Iv-- _ -14 Disposal eld: Distance from nearest well.-fi�AINC—Distance from foundation_ -t--------- Distance to-nearest lot Number of lines-------------- ent� ---- ngth of each line_____-"1�.=.----------_-.Width of trenth__a�_13__'------------•--- Type of filter material.__ _ epth of filter material'-_j$--------------Total length----��-_________-_______-_- .. d Seepage Pit Distance to nearest jll___ �____Distan�om.foundation_� ____._.Distance to nearest lot line__-- # Number of pits---._--_- __--------- .___- Lining material__._ _iri4_`lk.-----Size: Diameter_____.. ��`-_----.Depth--.___. ------------------ Cesspool- Distance from nearest well-----------------Distance from foundation_-=___------------------Lining material--._______---,_._._.__._________-._. ❑ Size: Diameter------------------------------------ -Depth------------------------------ ---------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-_.._______________-----_---____.._._ - ----------,_Dis#ante from nearest building------------------------------r------ ---- ❑ Distance to nearest lot line.................. Ramod.el ng and/or repairing (describe) ------------------------------•----••--•--------_.---------------------••---------- ---------------------------------- •---------------------------------------- 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 Local Health District. (Signed)..-------. ;�: V ' 4 --__._A___.- ---- Ow and/or Contractor -'-=� ----- ----- - -- ------ - - --- -- -------------- _ BY= - ------.- -'------------ -------------------------------(Title)----------- ---- --------------- (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse s � FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY------------------------- - -------- -- ------- ---------------------------------------- DATE-------- REVIEWED BY----------------------------------- ------- -------- _ ------------------ ------ DATE---- -- 1-1 BUILDING PERMIT fSSIJED ---------- ---- ------- ------------------------------------------------------------- DATE- ---- Gr Alterations and/or recommendations:------------- ------- -- ---- ---- ------------------------------------------------------------------------------ ------- ----------------- •------- a== -- :. _ -------- ----- -- --- -Z -------M ---------- :a -Rx, Z - -----------------------------------I----- ---- ------------------------------------ ------------------ -------------------- ----------- ---------------------------------------------------------------------------- FINAL INSPECTION BY:--------- ate._ ~ ate. SAN JOAQUIN LOCAL HEALTH DISTRICT 134 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 t45446 ATW000 12.54