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Y S APPLICAVON FOR SANITATION PERMIT Per it No. .-__`/--------- �4 (Complete in Duplicate) I Date Issued Application 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 Couty dinance No. 549. �� JOB ADDRESS AND LOCATION... Owner's Name-t--p- .��----------.Z ------------------------ ----- Phone--� � ' Address-------- �.j_�-4�'----------- -••--="-'-�=�"' �r----------------••- Contractor's Name _. ------------------------------- --- ----- Phone Installation will serve: Residence4tr Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: "-"l-- Number of bedrooms -A Number of baths -1- Lot size ---144d__°�'�rL -------------------------------------- Wafer Supply: Public system ❑ Community system E❑ Private N Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Pg Hardpan ❑ ti Previous Application Made: Yes ❑ No MQ ,New Construction: Yes ❑ No 1� TYPE OF INSTALLATION AND SPECIFICATIONS: `�\J (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-------------------.Material .__._____________________________- ------------- "&7 No. of compartments--------------------------Size-----•--------------------------Liquid depth--------------------------Capacity--------------------- Disposal ield: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line--------:-_-_-___ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of french----------------------------------- Type of filter material------------ g -----Depth of filter material____________ _ _Total length_.._______------________.______________ Seepage Pit: Distance to nearest ell___-{__ __---------Distance fr m fqu ation_...` Distanc`e,to nearest Iggt�II' ___ ____ Number of pits-------- -------------Lining material----_.--------___ -- --Size: Diameter---�Ac---------.Depth_.--fa3 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_________________.______--.________. ❑ Size: Diameter--------------------------------------Depth------------------------------------- --- ---------Liquid Capacity---------------- gals. r Privy: Distance from nearest well------_------------------------------------------Distance from nearest building____._-_____--___-____ ❑ Distance to nearest lot line---------------------- ----------------------- Remodeling anr repair' g describe) 't'e' �. T ? .�-------------------.... . .,!!. F-_--- r"---"''•. ------------•-----------------------------•----------•-------------..----------- . -----------------------------------------•------------------------•-- -•-------------------------------•------------------------------------------------------------------------------------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State , and les and regal tions of the San Joaquin Local Health District. (Signed) a•___ . . r ------------ = `q"" = = "` "= "'' {Owner and/or Contractor) '"f BY: --1 -- ---------------------------(Title)-- . r " (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 BYQDATE �.-r REVIEWED BY -------------- DATE BUILDING PERMIT ISSUED-------------- - --------------------------------------------------------------------------------- DATE--------V -------------------------------------------- Aiferafions and/or recommendations:--------------------------- - --------- -------------------------------------------- - -•---- --------------------------------------•------------------ FINAL INSPECTION BY------------- Date-- i 7 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 B-9--2M B-51 Revised W-2100