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V APPLICATION FOR SANITATION PERMIT Permit No. ... ..--- ---------- (Complete in Duplicate) Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to constr`y�t.and install the work herein described. This application is made in compliance with County Ordinance No. 549.; JOB ADDRESS AND LOCATION---- ---- -- ---`:f'-� 1- E�7-'F --t& 9� rr - Owner's Name----------3 Ue-------- O- �'1------------- ------------------- ---------------- - Phone------------------------------------- Address---------------- ----------------------•-----••----Address---------------- /........ Contractor.s Name------ -- ------------- •-----•------ ------------------Phone.1(6410-_J_6a----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms __`1/- Number of baths __/__ Lot size ------------------------------------ - -- Water Supply: Public system ❑ Community system ❑ Privateer Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No M New Construction:. Yes g No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted. if public sewer q. aillabl wit in 200 feet.) f Tank: Distance from neare0 weal �..C. Dist nce fro o anon Material---- Septic L _- No. of compartments_..._0"!%1_- Size ---------- -- ----- ------Liqui� epth_-.---- / - --------- _P --_Capacity__-:-; •-. �� -� Disposal Field: Distance from nearest well__Z�-�__Distance from f ndatio _,._ __t_ ___._:-..Distance to nearest lot line_.`AI_. Number of lines_________,___ rj Length of each.line______•.��_._._.___._. Width of french___.___'��____.__._____._- Type o1 filter material--- _a-------5e-_Depth of filter material_______ g__F__.Total length------,/;:2-&----------------------- d , 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-------------___._________________ 'Ilk❑ Size: Diameter-------------------=------------------Depth--------- ----------------- ---------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------•--_----------- ---------Distance from nearest building------------------------------------------ ❑ Distance to nearest�lot-line__t_:_______________ : -----•--------------------------------...._. ..,_ - •--tom....._ Rem ling anfor repairing (des�cri e}: ------- ---------- - --- "'-�_ �... k,v1 11� :. `.. :. .. sem --------- 2rr� »�--- � - ' ._.. ---------- --- � . '� --- -- ..R :. ------------ - - --------- ---- I hercWy certify that I have prepared this application and that the work will be done in accordar, iA San Joaquin County ordinances, Stat I s, and rules and re ulation the Satz Joaquin Local Health D115)11' (Signe ••---- ---- ------- ----- ---------- ---- wrier and/or Contractor) Y• (Title )-- - --- --- ------t----------- •------------------------ (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------- ------ REVIEWEDBY------------------------- - ----------:---------°-------------------------- DATE--------- -- ----- BUILDING PERMIT ISSUED---- ------ DATE------------- '---------------------------------------- -------- ------ - - -- Alterations and/or recommendations:__.._ -.---•-•-----------•------•-------•--••----------•----------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ----------------------------------- ----•------------•- ----------------------------------- --------------------------------------------------------------------------------- --------- -------------------------------- ---------•----------------•--------------------------------------•--•- ---`-------- - FINAL INSPECTION BY-------- ------------•----- -----_ -. - -:. : ._y'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 EE-9 145446 ATw000 "J