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APPLICATION' FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued ---.' $ _ Applica{ion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application i fade in compliance with County Ordinance No. 549. - �=�.f JOB ADDRESS AND LOCATION-- 41—r2_•_. d Owner's Name : 2 ''rt - ;, _._.-- Phone_+g._ adZ� - Address_. V. -••- d� i. - - ------------------------- Contractor's Name,<.7!% --------------------------------- Phone Installation will serve: Residence 40 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' ' Number of living units: -_ Number of bedrooms _ r. Number of baths - _.-_ Lot size ___ --_ drua..•---- _ ------------- Water Supply: Public system ❑ Community system 1B Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: - Sand ❑ Gravel ❑ Sandy Loam-�j Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Ej Previous Application Made: Yes ❑ No,,�j New Construction: Yes ] No F1 ; TYPE•OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weILO-!------Distance from foundation_ i� ^� Materia€ ----------------------------------- , ] No. of compartments-. -----------------Size9 ..r-�__7L! --------Liquid depth__._'_-_---------._Ca aci zr''_�t Disposal Field: Distance from nearest well_./OV------Distance from found tion_.�_Q............Distance to nearest lot line_-__�`- `_____- C Number of lines___.__-_ - Length of each line� l�---`--------------Width of trench.__:L� •�----_----- - - ------- ------------ ----`� Type of filter material'_t_Y(Ls _..Depth of filter material___-/-2"-___-__Total length----1. -'' ---•-----------••----- Seepage Pit: Distance to nearest well----------------------Distance from foundation___.-.__---..._____.Distance to nearest lot line____-__--_-______ �V ❑ Number of pits---------- -----------Lining material-------------- -------.Size: Diameter------------ ----------Depth--- ------------------------- Cesspool: Distance from nearest well----------------- from foundation____...............Lining material__----__--___-.---___-_ ❑ Size: Diameter------ ----------- -------------------De Depth, -- -- p = ------- -------------- -----Liquid Capacity-•---------------------------gals. Privy:' Distance from nearest well____............._-----------------------------Distance from nearest building ❑ Distance to nearest lot line----------------------------•--- Remodeling and/or repairing (describe):______________________ - ------------------ ----------------------------••------------- ----------- --•---------------•---------•-••--------------------------------------- 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 regulafions of the San Joaquin Local Health District. y (Signed)----��?------- i'_. -<_ gY�-- -=-�.�f'�.!-��_.�------- ----------- --��-- ----- -- � (O weer and/or Contractor) ---------------------------- ------- ----------------- ----- ------------------------------------------------- `---------------------{Title-----(Plot plan, showing size of.lot, location of system i relation to wells, buildings, etc., can be placed on reverseside).- FOR ide). .FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED - -�l __---___------- --------------- -- -------------- DATE- --------------- ------------ REVIEWED BY--------------------------------- -------- DATEE--------- ILDING PERMIT ISSUED------------------------------------- --------- DATE Alterations and/or recommendations-------------------- ---•-------------------------------•----- , � 01 ---•--- ----------------- .. ----------------------------------- fir - r FINAL INSPECTION BY: y� -�' = - Date-_ � _.`. W--• SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Sfree+ Stockton, California Lodi, California Manteca, California Tracy, California i ES-9 145446 ATWUCD _ f w