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APPLICATION FOR SANITATION PERMIT Permit No. ..__. ----------------- (Complete in Duplicate) Date Issued 2/- F6_" 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. 544, y� `.. JOB ADDRESS AND LOCATION-- --�-__ .. � :. s -. 3_a.X_ o -- • - -.------ :� Owner's Name----� . . ------------- Address----- Phone------------------------------------ Contractor's ---------------------- Address--------------R.�.c�-_.------------ ------•---- Contractor's Name.-----•-----------•-----•-_-- -•-- -_-- - ------------------•-------- ------------------•------- ------------------ Installation will serve: Residence's Apartment House ❑-"-Commercial"----".-•--"--'.---•"-------.-"------"-------- Phone_______________••"--_"--__----._--- ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �._ Number of bedrooms _ o`Z.. Number of baths J.___ Lot size _.___- Water Supply: Public system ❑ Community,system ❑ PrivateDepth to Water { Table .__. ft. � � � b"� { Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe Hardpan ❑ Previous Application Made: Yes ElNo� New Construction: Yes`�No E] TYPE OF INSTALLATION AND SPECIFICATIONS: - •�k (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) Septic Tank: Distance from nearest wel%z56-------Distance from foundation-1_Q_-_ /� Xr No. of compartments . Material_-.L . L._ _ i r p - ----------Size_._ -S xgyp~-------Liquid depth------- --------- Disposal 'i - � -----Capacity-•--- - fI Field: Distance from nearest well-152D_ Distance from foundation_-L-0-----__ Distance to nearest IPt fine_ Number of lines_---_0 { ' -. ngth of each line------ -- �-�- ----- Width of trench-.�_-X-- Type of filter material , -�- - - f filter material----/..,�---__--.---_Total length__..1 �_O__-"_ Seepage Pit: Distance to nearest well-._.------------------ Distance from foundation----------------- Distance to nearest lot line________________ JQ�``! ❑ Number of pits---------------- ----Lining material-------------------- Diameter_-------" --- - �.Z --------Depth--------------------------------- El Distance from nearest well___ _ Distance from foundation--..--_--_-_-_____.Lining material--_-__--__-_----.__.____. Size: Diameter. ----- --------Depth---------------------------------- ------------ ----Liquid Capacity-------•---- --- -----------gals. Privy: Distance from nearest well---_-----_---_---------------------------------__Distance from nearest buildin ❑ Distance to nearest lot line. g" "` Re deling and/o airing (de crihe}:__ a ' ---- ------ ,`- -� .. ------ --- ----- ------------------ ------ -- ----------------------------- 7\_ -------- - hereb certify that Ihave - ------ -•-- - •- ------ , ordinances, State laws, and rules ands regulations of the San Joaquin Local Heae work lltheDistrict. accordance with San Joaquin County (Signed)_- jp " # ' '•." ------------------- -----------------------------------------------------------------------{Owner and/or Contractor) SY� -------------•----------•----- •-- (Title) --------------------__ (Piot plan, showing .size of lot, location of system in relation to wells, buildings, etc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY--------------- APPLICATION ACCEPTED BY.__._____.-__..- --------------- ----------- --------- DATE �� --------- REVIEWED BY ------------ -- ---- ----------------------------------------------------------- DATE -•• BUILDING PERMIT ISSUED--------------- - ----------------- •-- --------------------------------------- ----------- Alter ,ions fin ./or rQcommendafions'_ ---- DAT _- - f }� _ _ � FINAL INSPECTION BY:__.--. -_-----.-.__--"--- -� �� -------------------- ------ Date 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-4 14"46 ATWOQD