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U II APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) fix-/ _ Date Issued -__- __ _� -� Applica{ion is hereby made to the San Joaquin Local Health District for a permit fo construct and install the work herein described. This application is made in compliance with County Ordinance No, 549. I�! JOB ADDRESS A�p LOCATION-._____ f� Owner's Name ------------ ph one Address---------- �--r5;2 / 1 -- -.C�._)_17.1A1-_d ` ----------•----------- ----------••- ` Contractor's Name-------- `''---`---- -----•---- ---------- Phone Installation will serve: Residence [_1Apartment House ElCommercial 23—frailer Court ❑ Motel ❑ Other ❑ Number of living units: __. Number of bedrooms ----- Number of baths ----I--- Lot size ------- C� �-c �- ---------------------- Water Supply: Public system ❑ Community system ❑ Private W 'Depth to Water Tabledu�_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe LR Hardpan ❑ Previous Application Made: Yes ❑ No �Z_ New Construction: Yes Rj_ 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----90 1.a------Distance frorlr� foundation------------------- �] Maferial_ —G --- ' No. of compartments------- -// -------------Size-------x12,------ -----Liquid depth----.-. �f--------Capacity------ -- ------ Disposal Field: Disfance from nearest well._____._Distance from foundation----- Number to nearest lot line —M-0 Number of lines_____..,/____--__ Length of each line.-_--_.4L2____ ---__ Width of trench._____2_ - --------------- J Type or filter materiaL-_/�_.__-`!__Depth of filter material-___..-l_Ig_._ __.Total length___..__I __f______•_--_- Seepage Pit: Distance to nearest well-----___--------------Distance from foundation--------------------Distance to nearest lot line______...________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------_.Lining material---------.___.____-__-._______.._ - ❑ Size: Diameter-------------------------------------Depth-------------------- ------ - --------Liquid Capacity----------------------------gals. Privy: Distance from.nearest well________ _ ------------- Distance m nearest building ❑ Distance to nearest lot line.--- s� p - -------•--------------------------------------- Remodeling and/o a air' g (describe):----- 2-��_--- --------------------------------- ------------------------- ------------•---•-------------------•---•---------•-----------•-------••-------------------•---------------------•--------•-----------------------------•------------- •- - -•--------------------------------- •- ' -----•--------------•--------•-------------------------------------------------•---------------•-•-------------•----------------•------•---------- - . r i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. ? (Signed',... Y� � = ------------------------------------------------------------ ----(Owner and/or Contractor) ------ By:-------- - -- ---- ----- (Title)-� ------- - - ------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATE-�------------------------ -- ----------------------- REVIEWED BY ----- BUILDING PERMIT ISSUED------------- DATE- ' `�`- ------------- ---------------- DATE---- ----------------------------------------------- Alterations and/or recommendations!-_.-.-_-_.-- _�-------------------------------------------- -------------------------------------------------------- ------------------------------------------------------ ------------------------------------------ ----------------------------•-----------------------------------I•---------•--------------- ------- --------------------------------------------- -------------------------- ----------------------------•------------•--------- ------------ ------------------------- ------------------------------------------•--------------------------------------------------•------------ FINAL INSPECTION BY:- _ Date------ SAAMOAQU__IN_ LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California es-5 145446 nTw000