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APPLICATION FOR SANITATION PERMIT Permit No. ;F (Complete in Duplicate) l� Date Issued Appllca+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. 544. JOB ADDRESS AND L CATION•-___-____ - `_ � �� d L S� - -------------- ------- -- Owner's Name----- ---•-- /-hEs0--------- ------ ------- --- ------ Phone-44---- �- 3 Address- ---------------0,, .� L -----------------------------------------------------------------•---------------------•----------- -•-------------- Contlactor's Name_ �� 'l ,S �. '/✓C `--------- Phone.-- 5._5___ __7 ---------- Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: .------- Number of bedrooms Z Number of baths : .- Lot size __ __ /D U WateSupply: Public system 0- Community system E] Private E] Depth to Water Table `s�_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam E] Cla NLoam F] Clay E] Adobe [;,Hardpan ❑ Previ lu s Application Made: Yes ❑ No New Construction: Yes ❑ o 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-____-_____--______________________ ❑ No. of compartments------------ --------Size------------------------------•_Liquid depth--------------------------Capacity Disposal Field: Distance from nearest well-----------------Distance from foundation------ -----------.-Distance to nearest lot line_____-_.._____--- �] Number o{ lines--------------- -------------------Length of each line--------------- -----------.-.Width of trench-- ------------------------------ Type of filter material------------------------Depth of filter material--------.------- .Total length------------------------------------------ Seepage ------------------- ------_- -------- Seepage Pit: Distance to nearest weIL 4 N _Distance from foundation__,?e'__/_____Distance to nearest lot line_-�_D_'___ Number of pits-----------l--------Lining material��(1:C.�...Size: Diameter__4-; "/,----Depth_.-_�a3 �___-_________ Cesspool: Distance from nearest wel!-----------------Distance from foundation.___--------------- Lining material__.---__--..____-__.____-___-_...- --- ❑ Size: Diameter-------------- ----- ------- --Depth-- --- ------------------------------- - -------•-Liquid Capacity----- ---------------------gals. Priv l r y:i Distance from nearest v✓eli-------------------------------------------------Distance from nearest building..............---------------- ❑� Distance to nearest lot line_____________________________•_-______-___------ -•_--__----._ N Remodeling and/or repairing (describe):------ ------------ ��M--------• ------------- --------•-------------------•----------------------•--------------•------------------------------------------------------------------------.-------------------------------------------------------------------------------- I --41I ------ --------------------I----------I-------------------a------_--a-----a----------------a-----------------------I---------a---------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. (Signe 11) 'IPl S H w � ner and/or Contractor) ----------------------------------------------------------- By:--- (Title)-----4e. Z (Plot pilan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). I� FOR DEPARTMENT USE ONLY �h APPLICATION ACCEPTED BY------------------------ ----- DATE------------- ----------- VIEWED BY----------------------------- DATE._. --- BUILDING PERMIT ISSUED.-_.•---------- ----------- ---------- r .: --•-----=-�---------------------- ------------------------- DATE.----------------- -� Alterations and/or recommendations:_._-- ----------- -I------------------------------------• /;-------------- ------- --- ------ - - ------------------------•------- -•----• --;---�----•----- `n"�I" ----- Ir-------- ----------------- = --------------------------------- ------- ------ s-------------- ------=------�-- -- - ------- --------- ------ l� --------•-------------- ------------------------ -- - FINAL INSPECTION BY-------------- - ---------- Date------.... �S SAN JOAQUIN LOCAL HEALTH DISTRICT 136 South American Street 300 West Oak Street 132 Sycamore Street $14 North "C".Street i Stockton, California Lodi, California Manteca, California Tracy, California E5�9-2M 145446 ATWppp 12.54 �I