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APPLICATION FOR SANITATION PERMIT Permit No. ----- ..!---7 4' (Complete in Duplicate) Date Issued 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 OCATION----------- ----- 1 Owner's,Name ------- G --- Phone. Address--------------------- -- -•-----•-•--•------------•--•-----------------------------•-------------•-�--�-- -------•-------------- �. Contractor's Name............... ----__ _ PhoneA( ._ - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�-- Number of bedrooms_. Number of baths __f__ Lot size _____ cS�---?L --- G-rF_---_____- - Water Supply: Public system FZY Community system ❑ Private ❑ Depth to Water Tabl,_' ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ej Clay Loam ❑ Clay ❑ Adobe, Hardpan r ❑ Previous Application Made: Yes [❑ No Z New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic'Tank: Distance from nearest well-_./V0 stance from foundation.... _ Material _ _ h•4iv-----__----- . - ---------- No. of compartments ---Size__ depth ~'" p - --- •-• - �-- -.�__Liquid -_._._�!'J --- ---CapachY----��--�------- -f Disposal Field: Distance from nearest istance from foundation___Z&a----------Distance to nearest lot line.-__,fid L9Number of lines--------j.....1.1 ----------Length of each line------ ._.__�-�---Width of trench------�n$L ---- ------------ Type or filter materiaf./�._-_,�._ -Depth of filter material-------�.S7._-..._-.Total length-------Z-3Gg- _---_____-_ Seepage Pit: Distance to nearest well.1V1h-_r!_Distance from foundation______ 4 --- 2 _ ___.Distance to nearest lot line____ Number of pits_______ _--------_...Linin material _ e Lining e: Diameter___- Cesspool: Distance from nearest well--------_--------Distance from foundation---------------------Lining material------------------__.__ ❑ Size: Diameter----------------- - ------------------Depth------ ----------•---------- ..... -- ._Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------- ------------------------------Distance from nearest building------------------------•-------- ------ ❑ Distance to nearest lot fine------------------ ------ _-_---- ----------------- Remodeling and/or repairing (describe):--------- ______________________ G ------•-------------------------- --------------------------- ---------•----------••- ----- --------------- --- ---------------------•------•----•----------------•--------------•---•-------------------- --------------------- ----- W I hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfa a s, and rules and regulations of the San Joaquin Local Health District. (Signed)•----- -----`l- ------------ ----- ------------ ------(Owner and/or Contractor) BY:---------------------- - -- - - ------ --------- -- ---- r -_. --- -- Title-------- =----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- ------ DATE---------- — _ ----- ------------------•------------------ DATE�5 ---------•----------- �) REVIEWED BY--------------------------------------- ------------------ C-------------- ---------------------- --------------------- BUILDING PERMIT ISSUED ----------------------- Alterations and/or recommendations_ ________ -------- ----------------------•-----------•--------------------------------------------------- ----•----------------------- ------------------ ---------------------------------------------------------------•---------------------------•-------------------.....--------------- FINAL INSPECTION BY:-- i/ ./=y -A Z— 2.0 - SG ------------ --- - ------ 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 E5-9-2M 145446 ATWODO 1Z-54 E°1