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APPLICATION FOR SANITATION PERMIT Permit No. -___-��...�.. (Complete in Duplicate) Date issued ________�d,_�.� Application is hereby made to the San Joaquin Local Heal#h District for a permit to construct and install the work herein described. This application is made in compiiancerwitLh County'Ordinance No'. 549. � y" —---------------------------------------- " ' -' " -JOB ADDRESS-AND LOCATION �` !,_Xt---- Owner's Name '- - `� s ----'-------- - ---------------- Phone---------•-----------•-•------------- -- � 1 Address_ y ----------------•-*--------------- Contractor's .... Name. "" ..-__Cl__ _ _____ __________ - --- - -------------------------- Phone..------------------•-------- --- Installation will serve: Residence ❑ Apartment House ❑ Commercial qv Trail r,Court ❑ ore] ❑ Other ❑ .. , . Number of living units: Number`of bedrooms _-"___ Number of baths Lot size„__ __: _ _ '_ ?_ _ Water Supply: Public system Community system'❑ Private ❑' Depth to Water Table --------- ft. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ®' Hardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ v TYPE OF INSTALLATION AND SPECIFICATIONS: k (No septic tank cr'cesspool permitted V. public sewer is available within 200 feet.) /.e �} �.�.. Septic�Tank: Distance from nearest well_- _ d�Distance from foundation Material-- ____________ '+�❑ No. of compartments • Size LiqW`_ th r :Capacity '#' Disposal Field: Distance from nearest well WV[Distance from foundation, �3_.Distance to nearest lot line_.--'!'-----____- ,. .- ~� Number of lines--------- /'---- ----------- Length of each line_ 1�__+ _-., -"----.Width of trench-------- - - ----- -- f Type of filter maferiAl- of fil#er-materiaL._.___}_ _r _____Total length__________, ' _--____�`�.. ++ n= ee^ag�e t: Distance to neare$t well,_'__: ------------ Distance from foundation--1,211 ------- ----------Distance to nearestjpt line__ .______ Lid' Number of pits--1------------------Lining material_ A---------.Size: Diameter_3-,3.............Depth------------------------------ -om Distance from nearest well________________!Distance from foundation-------'----- ----- Lining material_____..________.____.________________- ❑ r tip -Liquid Capacity----------------------------gals. Size: I.3iameter-------�-----------------------=----�De th--=------------------------•------------- - - - - Privy: Distance from nearest well____._.___-__4-------------------------------Distance from nearest building__________.___._____________-__-_-_-___._ ❑ Distance to nearest lot lire-------- ---._r----- ----- --------------------- -- - --- - --------------------- --------------------------- � ! V, Remodeling and/or repairin'� (describe) ----------------------------•--------•------------------------------------------- -----------------•------•------- •--------- --------------------------------------•-------------------------------------------- -----------------------------------------------------------------------------------------------�`----------- -------------------------------------------------------------•---------------------------------------------- I hereby certify that I have prepared Ais-applicafion and that the work will be done in accordance with San Joaquin County � ordinances, State laws, and r,Gles and regulations of tele San Joaquin Local Health District. (Signed)-•----"�-'-- - ?------------------------------ -------------------------------------------------------------------------------(Owner and/or Contractor) f By:--_----------------------------------------------------------------"=-,r--w--------------------------------------------------(Title)---------------------------------------------------------------- (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 REVIEWEDBY----.--•-----=------------- -V-------- ------------ •----•-------------------------------•--------•---•----=- DATE- ----•----------•--------------------•-------•------- BUILDING PERMIT ISSUED------------- -------- ---------------------- DATE---" --------- Alterations a d or recommendations:______ C _ __ Win___:_ _ 1 ____,�" �r�_. ------------------- --- - ---- -- ---- - - � _V-- -•-- --.....------------ ` ----------------------- -------------------------- . ---------------------------------------- ------------------------------=-------------------------------------------------- -----:-------------------------------------------------------------------------•------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:----------- - 1_`........... ______......________ � Date-----:-[�--~-2_-�� ----------------------------------- 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-9---2M , Pevisea 1-57 F.P.CO.