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APPLICATION FOR SANITATION PERMIT � Permit 4inescribed. (Complete in Duplicate) 1Date ssuedl -------Applica*ion is hereby made to the SanJoaquin Lotal Health District for a permit to construct and install the work her This application is made in compliance with County Ordinance No 549, JOB ADDRESS AND LOCATIO -- ------- --- . ------- -�--------------------------------------------- Owner's Name------------ --- ' ----... - '•.•----- -------------- -------------------------- Phone------------------------------------ Address-----------------"�- ✓ -` ��?�--- -------------- ---------- ------ - --------- --- / Contractor's Name-----=---•-- �l.- ."rte d- 1---- Phone-- •----- Installation will serve: ,Residence [A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a Number of living units: N ber of bedrooms wZ--_ Number of baths Z--_- Lot size ...... __,/r-I__�__ __________ Water Supply: Publicfsystem C6mmunity'system-E] Privste ❑—Depth to Water Table ft. Character of soil to a depth of.3 feet: :Sandtravel E] Sandy Loam [j lay Loam ED Clay E] Adobe Hardpan E] s Previous Application Made: Yes E] No 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-___-______._____._________________-_--___-_. No. of compartments----------,-�-�----- -5 ze---------------------= --------Liquid depth--------------------------Capacity...-------------------- ` Dispose# Fier; Qistance from near%,'t well�!�`_ __.Distance"from f6undation___-_-�_�_-._.Distance to nearest lot Ike__C__ -- Number of lines,__:'_ Length of each line--- __J_. Width of trench__-_.�--r______________ yp r �l� f_ plength - T e or filter material,_ -_ _____! -_Depth of filter material ___-._- -------------------- s eepa ___________________Seeps e P- • Distance.to nearest;wel __Distance from fo ndation _;.__._."pistance to nearest lot line___ _____________ Number of pits:: • g Depth-------Z's--------------- 1 I _ --___Linin material_ ._dJl� __-.__.Size: Diameter_.___ __--. N Cesspool: Distance from nearest well------------------Distance from foundation-_------ --------- Lining material__.__._______-_______-__-_________. -r 4 ❑ Size: Diameter f Depth_..__. .--------------------- ---------------------Liquid Capacity----------- --------:•--gals. Privy:" Distance from nearest well----------------------- ----------------- Distance 5from nearest building.___________________________-______.___. V ' ❑ —Distance-to nearest;lot line___._.._� _ ___r_ ® 1 Remodeling and/or repairing [describe) t ��' ------------------------------ `Y��- ,h ------ -----•-----•----------------------------------------------------- ---------- --- ---------`'--------------- ------------=--------`---------------- �'--�--- -------- -------------s----- _ ----------------- --------------•-----------------------------------------•--•------------•---------- --•---- •• --- --•------ ----------•------------------------------------- --.---------------- IFhereby certify that I have prepared.this applicatio nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of.A n Joaquin Local ealth District. i . . (Signed)------•. _.`_..._ = �; 6 � 7- )Own and/or ontractor) - _ Cfl ` sY= _ -- `------- = = (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 . t APPLICATION ACCEPTED BY-- ---t-t------------------------------- ----------(---------- ---- DATE------------- ";► ------------- REVIEWED BY ----------------------- ----------------------------- ---------------------- ---------------------------- ---------- DATE--------------- ---- - BUILDING PERMIT ISSUED--- -----------=------ -- I ----------- DATE-------------••----- � , I 4 Alterations and/or recommendations.----r--------•----------- --------------------- -------------------=-------------------------------•--•---------------------------------------------------- -----------------•--------------------;-:---r----------•------------------------------------------ -----------•------------ ---------------------------------------------------------------------.--------------------•---- -------------------------------- -----------,---------------------------- ------------------------------------------------------- - •�' } F1NAL INSPECTION BY:.-� Date_..-------------=----_ e-----------:---------- 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--9-21u1 Revised W-2100