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APPLICATION FOR SANITATION PERMIT �1 Permit No. �-- (Complete in Duplicate) - Date Issued __��3�5�- 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-____-- ---- •- ------ -- - �----- Owrter's Name--------- -- r= E Phone---- A Address____ -- Contractor's Name____.___-_ ------ ---�'-_ - -- / --------- ------------------ --------- --•--- Phone. Installation will serve: Residence 4—Apartment„House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] , Number of living units: _1__-- Number of bedrooms __ - Number of baths ,_/"- Lot size __-, t Water Supply: Publics stem 4 ---------------------- , �.^ s Y L Community system ❑ Private ❑ Depth to Water Table Y,I_:ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay Previous Application Made: Yes El No El New Construction: Yes E] No ❑ ❑ [:] Adobe [ �F{ardpan E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) V Sept- Tank:_ Distance from nearest well__-__.__.._"_____Distance from founda#ion...__ r Material --- No. of compartments ------Size-------•----------------•-------Li Liquid. depth p Capacity ---- ,.Disp-aal F' Id: Distance from nearest well"................Distance from founda#ion____-__."_._.-._....Distance to nearest lot line__.____,_--•_-.-- Number of lines__.--_______"---_ .' ----------------Length of each line---_-----------------_----- Width of trench. Type of filter material-------------------------Dep#h of filter material- - Total length ---------------------------- Seepage Pit: Distance fo nearest well..Ar?-----------Distance from foun�ation_60-----------Dim f fe to nearest lot line_-.e_----_ Number of pits._..f"_________ ____Linin material_ _ - , - 9 = �.-. Size: Diameter_"'A, --Depth ---�------"--•------ El _ Cesspool: Distance from fe nearest well____ Distance from foundation-----_--------------Lining material-----_-------------------------------- Privy: -----------_ -- - ❑ Size: Diameter----- --- ----- -- - �-----.Depth------------------------------ - ---------- -------- ------- Liquid Capacity-------------- -------------gals. Privy: Distance from nearest well__.__---_------- .-_--- __-Distance from nearest buildin h ❑ Distance to nearest lot line-------------------------- building.----------------------------------------- I • -------- - ------------ Remodeling and/or repairing (describe):-------- --� ------------I------------------------- k -o- ----------I -------------- - ._ -- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- ---------------------•---------- ---------------- ---------------• I ----------------------------------------- ------------------------- --------------------------- ------------------------••------------------------ -- -------- --------------------------------------------- -- ---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local,Health District. (Signed)----------------- `6", By:--------------------- -------- /t✓ ----- - _fi Contractor) ) -------------------------------------------- (Plot ----------- -- - -- -- (PIo# plan, showing sizeof lot, loo n of system in relation to wells, buildings, etc., can be placed on remove se'4idej. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._..__-----_ - -- ---- ---- ----------- DATE-------- EVIEWED BY ---- BUILDING PERMIT ISSUED._--------------------- ---------------------------- DATE . ---------- DATE-- ------ Alterations and/or recommendations:___.______ -•----------- --------------------------------------------- ---------------- - ----- ---- ------.r ---------- 1-5- - ------- ----- ------------------------------------- ---- FINAL INSPECTION BY ------ ------ - /�,.. Date ---- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Streef 132 $ycamoro Street 814 North "C" Street Stook+ort, California Lodi, California Manteca, California Tracy, California E5_9. 145446 ATW000