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APPLICATION FOR SANITATION PERMIT Permit No. fJ__l....-/. n [Complete in Duplicate] Date Issued ___._ J Application 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 withf County Ordinance No. 549. JOB ADDRESS AND LOCATION Owner's Name r ---- --------------- ----- Phone Address------------- - ---- N � Contractor's Name______ _ --- ---•---- -- ------- -- ��<ar`tment_,H_ouse__F Installation will serve: Residence Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a< a Number of living units: .�umber of bedrooms _-_ Number of baths _--L___ Lot size . '� ;,.Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table `,L_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe M—Hardpan ❑ ~ r Previous Application Made: Yes ❑ 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 : Distance from nearest well-----------------Distance from foundation__._______..--____.Material_-_____..__.__.__.__.__._______,.__-_________. aQn No. of compartments --------Size--------------------------------Liquid depth--------------- ---------Capacity----------------------- Di! osail -- - ----------------- Disposal ,Fie d: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line._---_--_--__--- .x�Lw� Number of lines-- --------------------------------Length of each line-----------------------------------------------------Width of french-------------- Type of filter material_________________________Depth of filter material---........__--.-------Total length----------------------------.------------- - Seepage Pit: Distance to nearest weil... � -Distance from foundation-__1a------------ .Dist,nce to nearest lot line--- S ______ Number of pits------t---------------Lining material-_ ---------Size: Diameter-------a_��IF--------Depth......3- __.________._ esspool: Distancenearest well----------------- tce from foundation-------------------- Lining ❑ Size: Diameter Deph - . -______ iud Capacity---------------------_.----_gals. Privy: Distance from nearest well..._......... -------------------_------------__Distance from nearest building ❑ Distance to nearest lot line___________________..___.__....____-_________..__________ Remodeling and/or repairing (describe}---------- ------------------<,,� ______- ? ---------------------------------•---•--------- --------------------------------------...__ --------------------------------------------------------------lJ -------------•-- ------- -----------•-----------••----------•--------•------------------------------------ ------------••----------•---------------------------------------•---•-----------•----------------------- I hereby certify that 1 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);----=---=---- --- ------•--- ----- --�-w.�_.-- ------------------------ --- ------------------- -------------------------- � --(Owner and/or Contractor) By: --- - ----------------------------------------------------------------•----------------------------[Title) p3� - ------------------ [Plot plan, showing siz f lot, location of system in relation to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- -- ........... ------------------- --- ----------------------- ------ DATE..---------•----- - - - - -- - ------ ------ ------ --------- --- REVIEWED BY---------------------------------- - - --- ------------------- - --------------------------------------------------- DATE ... ------ BUILDING PERMIT ISSUED. -----------•---------------------------------------- DATE D ----------- Alterations and/or recommendations-------- ------------------ ------ -- - - - - -• ------- /__T.._G'y i��SE .- r �L�_ .�..._L 1_!✓C __ 4�<1Gtl !1 ----------- ------------ GU1__f2cr. l 'Cc�F 1- �- P r`d ---- '--------------- , r 4 C�.h / 7 -------- ---- ----- - - ` ""..`. ?.-------- �•-Q ' FINAL INSPECTION BY:.----- 'his/--- ---------------------------- Date_----- --- SAN —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 145446 ATWOCO