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�\A (o 0 o S a\ APPLICATION FOR SANITATION PERMIT Permit No. ....... . ...5/....... (Complete in Duplicate) /T'/S� - 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 LOCATION. , '5�r �i��t?�.G �y � � '►� ----- --- -------- -......-.. - - Owner s Naem�e_...../..1.!�4.k�------1�,.. .. ... - --.... ............ u - ---------- •------...... .- Address--/()- - .'._.. � • . .. --------•.............:_.----------:_........ Contractor's Name........ `./f .. —. Phon024. ` Installation will serve: Residence'❑ Apartment House❑ Commercial a Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .....:.. umber of bedrooms -------- Number of baths ..RZ_ Lot size ... ad- ?��!�.0.1 ...................... Wafer Supply: Public system [L 4ommunity system ❑ Private ❑ DeptK:to Water Table 'y4lft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay❑ Adobe[-lardpan ❑ Previous Application Mede: Yes ❑ No g `New Construction: Yes ❑ i No TYPE OF INSTALLATION AND SPECIFICATIONS: 5 ' (No septic tank or cesspool permitfed if public sewer is available within 2004"t.) _ _ : �ank: Distance from nearest well.................Distance from foundation................ --.Material ..... _...... ...,..............:...... No. of compartments.,..... ". ................. -- ............Size........---- ..liquid depth......---............--..Capacity---.................. isp L Field: Distance from nearest well......:.:......Distance from foundation.:................Distance to nearest lot line................. Number of lines.. of each line........................._..Width of trench.... Type of filter material.........................Depth of filter material--------.--------------Total length......................................... Seepage it: Distance to nearest well?Y .Distance�r,o,m,fo}+ndation....A .......D?ista;ce to nearest lot line..!!�........ [ Number of pits.......1.............Lining material`. ._.Size: Diameter.._..0A..._._.`_"-.Depth:;_!u �................... Cesspool: Distance from nearest well.................Distance from foundation___-..-..-..........Lining materia ............................. ❑ Size: Diameter-----............:: .._,...Depth.......... ------------0.._...................:....Liquid Capacity................ ._-;-gals. Privy: Distance from nearest well..'............. Distance from nearest building......................._.............. ❑ Distance to nearest lot linea:.....--------------......--- ... --.......................I............................-- -----..........--........... r r Remodeling and/or repairing (describe):_......................... ..............._....:..............-.............................- - ... r , ..........-.—........................._.............................................................-..............................._._......._.._......................................... -... ..............................................................................__..._........................._......................._......................-................................--------------........... t - hereby certify that 1-have prepared this application and that the work will be done in accordance with Sen Joaquin County ordinances, S e laws, rules and regulations of the San Joaquin Local Health District. (Signed)..:.. ... :-.. Q - - ---- -10 er and/or Contractor) By:---------- - > '---•-- ----------__..........._I......... (Titl (Plot plan, sbowidg size of lot, location of sy' min relation to wells, buildings, eio, can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.--- - ..... - DAT ...... - .... ............ REVIEWED BY----....-•-------_-------- ---------- - .......... • DATE.... ........ e ---.....__...- - -- BUILDINGPERMIT ISSUED---•---------------S ..... .. ............-....••------............................. DATE--------•-- ........._r...J............------- Alterations and/or recommendations....... - -- --- , .y�- ---------•--........_:----------------..... .................. ...... ------------- _.......:. ..._.......... ....................................•...•..........---- -----•------------------------------------...-------------------------- --------....._.------_ - -- ....................._•----.................. ................ ..... ................. .................. - - ------...._ .... - . .....------.......,. FINAL INSPECTION BY _: .�......_--._----------------- Date..'- ------- .-_. ...._./. .._._.r......:._._..._. 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