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,� APPLICATION FOR SANITATION PERMIT Permit No. ....' �S•7ti� ` ��" (Complete in Duplicate) _ 3 %App Date Issued ication is hereby madelt the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in�mpliance with County Ordinance No. 549.�rr y JOB ADDRESS AND LOCATION_------------------------)-5.2.3------------ � 1 1 Owner's Name-------------------------wt1rJJ_SAef.'----------------------------------------------------------- -------------- Phone------------------------- Address----------------------------------------------------•--•--- Contractor's Name------------------ 6,5b----------- e -1{ '----------------------------------------- ..... Phone-----------------------•-------• - Installation will serve: Residence V Apartrfient House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f r Number of living units: -------- Number of bedrooms __-1____ Number of baths -______. Lot size --------4� __ ___._____ _ ____.___.__ Water Supply: Public system I; Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No 9 New Construction: Yes ] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) n�,� Septic Tank: Distance from nearest well____O_-___Distance from foundation____.______.__.Material__------- I�fl_io�d--------------------` No. of compartments------ - --Size-------- X ..Liquid depth---------G1�-_--------Capacity----�5�- -----� Dispo I Field: Distance from nearest well----.N_Q------Distance from foundation______po_r_____.Distance to nearest lot line-------- Number of lines-------------;------------------Length of each line---------3P----------------.Width of french----------!]!?-----------------_ W ' Type of filter material"_"__"____I _________Depth of filter material______Ly.y_---____-Total length______________r0___�___------------ Seepage Pit: Distance to nearest well____ _______________Distance from foundation--------------------Distance to nearest lot line------____---__.-_ M ❑ Number of pits-------------=--------Lining material-----------------------Size: Diameter-----------------------Depth-------------------------------- • Cesspool: Distance from nearest well-------------_---Distance from foundation-----.--------------Lining material-----------------.--.__--___.__..__ ❑ Size: Diameter-------------------------------•------Depth-------------------•"-------------------------------Liquid Capacity----------------------------gals. JJ Privy: n Distance from nearest well-------------------------------------------------Distance from nearest building-------------._________________.______.__. � ❑ Distance to nearest lot line--------------------------------- `T Remodeling and/or repairing (describe): ��-'�- ------------------------ -------------------------------------------------•----------------•-•----------------•-------•--------- .._... ---- --------------------- --------------------------------------------------------------------------------------------------------------------------------------- - ;� - ° -'"•---------------------------------- ------------------------------------------------------------------------------•------------------------------------ -----------------••-i��----------------------- _------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in a cordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------------------------------------------- ------------------------------- -----------------------------------------------------------------------(Owner and/or Contractor_ By-------------------------------------------------------------------------------------------------------------------------------------(Title)-------------------------------°-------------- ---------------- (Piot 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---------------------------- -- DATE BUILDING PERMIT ISSUED---------------------- ------------------------------------------------------------ DATE-- ----------------------- - ---------- ----------------- - __ f " j1.,f f x CAlteration and/or recommen do _ . _______._ f--- ---- r�"��S � k t r f1 � - ------------=----------- --- ------' --------- ----------------------- ---- t'�°�-----j�------------------ ----- ----'°�'-------/9 3---- -�=---.".� ---------------- _ y FINAL INSPECTION BY:---------------------------------------------------------------- Date-- --------- ----------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West 0A Street 132 Sycamore Street E14 North "C" Street Stockton, California Lodi, California Manteca, California firecy, California ES-9-2M 10-52 Revised W-2100