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APPLICATION FOR -ANITATION PERMIT Permit No. ...C..-l(_1_1_�' (Complete in Duplicate) ! / W 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 Ordinance No. 549. JOB ADDRESS AND LOCATION--------- ' t'' cr"� ---------------------------- Owner's Name--: - ----- � ��f��. Phone--- Address------------- -1+ ------ -------- sew 3`S y ... ---^ Contractor`s Name....._. '"Z'------ ----- Phone_ "- Installation will serve: Residence V-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ____S__ Number of bedrooms ...1 Number of baths ____1___ Lot size __.__j '_ � � _______________________.__-- Water Supply: Public system ❑ Community system E] Private [Depth to Water Table . --- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [P-'Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes [jKNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan4: Distance from nearest well------------------Distance from foundation------------....----Material____-_____.__________--___________---__..___._.- E No. of compartments----------- - - ----- ----Size--------------------------------Liquid depth------------------------ Capacity----------------------- Disposal Field: Distance from nearest well-------------___Distance from foundation_____.______..___-.Distance to nearest lot line-------------_-- Number of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material--_--- ..------Depth of filter material----------------------Total length________--________________---___-_______- See a e'Pit: Distance to nearest well . A-..----Distance, �from foundation--A4 -.�„_.Disfance to nearest lot l�i e__.��_r Number of pits------i------------..Lining material_+..._-.---.-Size: Diam ter__.._�Q -- ---Depth..--I's__`___________________ Cesspool: Distance from nearest well_________________Distance from foundation----------.----_--- Lining material--------------------------------------- El _____.-___ -___._.____-----______.❑ ^Size: Diameter--------------------- --------------- Depth.---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well_________________________________________________Distance from nearest built#ing____----__.__________----______________--- O ❑ Distance to nearest lot line--------- --------------------------------------------------------------------- ------------------------------------------------------------- Remodeling and/or repairing {describe):_..P"Aki 5 --- -; ------ ---- ----- --- ---4,.` ----!_1 ----------------------------------------------------•---------- -----------------------------4------------- --- ------•------------------------------- ----------------------------------------------------------------------------------------------------------- - --- -------------------------------------------------------------------------•--------------------------------__------------------------------------ ---•-----------------------------------•------------------------•--- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County u ordinances, State laws, and rules and regulations of the San Joaquin local Health District. (Signed)----- ------------------------------------------------ (Owner and/or Contractor) , BY: Sv1."R-4 -q'� �` y�`' {Title ' 1 (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-R! ---------------- DATE-- 3~ REVIEWEDBY s \-- ----------------------------------------------------- --•----------------------- DATE--�-�-------------------------------------------- BUILDING PERMIT ISSUED------------ --------------------------------------------------------------------------------•--- ` - ---- --. ._ D_ATE--- ancrecommendations __________________ _- . _ .._-...- Altere o ., - ------------------••--•------------------------- - 4-_.-------- ------------- --------•--••----------- ---------------------- FINAL INSPECTION BY:------ _ --5_._..-._ � — ) --. ----•---------------- Date---------------•------ - -------------- ------------- -----------------•--•- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street I Stockton, California Lodi, California Manteca, California Tracy, California 145446 ATWDDD