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1 b 10 l APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San`Joaquin Local Health District for a permit to construe nd install the work herein described. This application is made in.compliance �viAh County Ordinance Q. 549. JOB ADDRESS AN CATI N- �U --_ _ -- 7 � ~ Owner's Name_ �- --------- T n r --------- -�j --------- # L [ -----------••------------------•-----------------------•------------------------------------ Address-------- --•- - ----•----•------- C" 4 �L� 'sc <- --------------•------------------ Phone- �� . Contractor's Name_-_-- '_-- �-`------�" ---- Installation will serve: Residence [�-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _?____ Number of bedrooms --- - Number of baths ___. Lot size _""____ Water Supply: 'PublicIsystem'❑ Community system [.X Private ❑ -Depth to'Water Table c � t Character of soil to a depth of 3 feet: ;Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobea Hardpan ❑ y Previous Application Made:- Yes ❑! No II New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .-t - 1. - L Septic Tank: Distance from nearest wel# ,from foundation --_.-.-_.Ma# na - -C_ _.. `�kQ______Distant . 6 _ Liquid de th_______�---------------Capacity - /d-- No. of compartments -------------Size---------- p tY f ") Disposal Field: Qistanc6 from nearest well-_,2A _. Distance from foundation--/-.4--- -____Distance to nearest lot lin -_..._ Number of.lines-____ 1---t-- f--------- -Length. of each line-------- �-=1 ,Width of trench---- 5 �---------------- Type of filter material_jr' -'__ :_Depth of filter material___-__467-__Total length__"_____._i: ______________________ �► E Seepage Pit: Distance to nearest�well_.�__(��_ _Distance from f u da ion___-_____�___._.Distanc•,e�to ,nearest lot line---- .____"__. ° Number of pits______ ____________Lining materiaL__4 _ � tie: Diameter__ ._______.Qeptn_--- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation-__-_-_-____t__---Lining material----------------------------.-------- C El 71 Diameter_ = D.eptly---------------1------------------------ --------Liquid Capacity----------------------------gals, PrivDistance from nearest well___________ __-- est building______--�_--:------------- --Distance from near ___-_____---____________---_---- --. Privy: - ----------- - - - Remodeling .,.. .. � Distance to nearest:lot line----------------- ----------- - ------------- ----------�------••----�=�-----'------ -Y"--"----------- -- ..-- "- <-t '•_-------•---------------•-------------------- Remodeling and/or repairing (describe}:____-__'. �_ __ _________"--�-�-�-- -�•--•- -• -- 7 -----------•---------•------------•----------------- ---•"------ •------------------------ = = ---------------------------•--------------------------------- - ----- --I--------------------------------------------I-------I-----------------------!.......... ---------------------------------------------------------------I-------------------------------------- -------- llhereby certifX that I have prepared this application and that the work will be done in accordance with San Joaquin County ` d regulations of the San Joaquin Local Health District. ordinances, S#ae Is, and res anr t ter, �`, i --------------------(Ow r and/or Contractor) [Signed} ffffff ------------------'- --- -- y. _ " _ (Title) ------A** 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 BYE----__________________"---------------- --------- - -----'------------------------ DATE_,----------------------------------------------------- REVIEVI/ED BY- ------------- --�-`- DATE �` - :_.. BUILDINGPERMIT 'ISSUED-------•-- ------------------------------------------_----------- - _--•-------------:-- DATE <---------------------•------------------------ Alterations and/or recommendations: =------ ---- -- •----- -- ----••-•--------------•----------•---------- •-•----- ------------------------------- i f ------------•----------------------------•--•--------------------------- --- --------------•�-�-------- ------ I ---------• ------•----•-----•---•--•---------------------------------- I '� r ` =------- ---• ,,..- _.,,�_. _ .,..�. - Date:_:':-.'`- --v r`f-.'--�•�-=-------- - ---------------------• FINAL INSPECTION BY:- _�----------------- -- SAN JOAQUIN LOCAL. HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 Forth °°C°° Street Stockton, California Lodi, California Manteca, California Tracy, California „ __ ."Oe - E5-4-2M ; • Revised W-2100 _ _,_ –