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c APPLICATION FOR SANITATION PERMIT Permit No. ---'1--�__ ------ L� (Complete in Duplicate] Date Issued ----q/f L Applica*ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal] the work herein described. This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION . ' ��'�"-'-- ------------------------•---------•-•----------------• -- Owner's Name---------- Ci,r�---- ------------ - ------------------ ------ - ----- -- Phone------------------------------------ -Addr --- ess-------------------- - ------------- ------4•-•---•----•-_------------------------------------------------------------------ Contractor's Name------ ---U,/- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I-_._ Number of bedrooms __ _ umber of baths ---I--- Lot size .______________________ Water Supply: Public system ,® Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2K,Hardpan ❑ Previous Application Made: Yes ❑ No D�_ New Construction: Yes a 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--/'1/0-lOistance from foundation----Z40___-------Material-_.__ - -- -c �- _-_-----. No. of compartments.-___-- q �_----------Size---��--�'-��---Liquid id depth----- ....Capacity------/_-Gz3---r- Disposal Field: Distance from nearest wet.N./yie_Distance from foundation----14__-.......Distance to nearest lot line-__-fp;��_____ ® Number of lines-----------_ Length of each line_______,,,__--_,_____.Width of french-.---. .4�____________ l-I--- --------- si Type of filter maferial-Y-4---.5.kt_._._Depth of filter material....../�_.-_-------Total length--------5ro-________________________ Seepage Pit: Distance to nearest well----eA4 Distance from foundation_____,_-?-W_f__-.Distance to nearest lot � 6 Number of pits---------1----------Lining material-'—Z?-"Ldfi'ze: Diameter.___- � _.Depth--_-_ �___________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__.----------------------------------- F1 , -__-________-._.___________-_____.❑ , Size: Diameter------------------------------------------------------Depth------_________--------------------------------- .__Liquid Capacity-------------------------__gals. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-------_------------------------._____.._- ❑ Distance to nearest lot line----------------------------------------------------------------------- ------------------------------------------------------------- .7 Remodeling and/or repairing (describe)--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ------------------ -- ----------------------------------•--•--•-------------------•----•-------••------------------------------------------------------------------...-----------------------•------------------------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. (Signed] Gl/ - �� - - ------------------- ---- --- ---- ------------ {Owner and/or Contractor) $Y: f �=��- - ----------------------------------------------(Title)-----� '---------------------------------- - - (Plot plan. showing size of lot, [ocation of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- --- ------ ----------------------------- -- ----S_$; --------------------------- DATE------------ r"5----------------- REVIEWEDBY--------------------------------------- ------------------------------------------ ------------------------------------------ DATE------------------------------ -- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.----------------------------------.------------------------ Alterations and/or recommendations--------------- ....................... .........--------------- --------------------------------------------------------------------------------•- / �y�' 2 -2-,, - S6 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-9-2M 145446 arwOOD 12-s4