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APPLICATION FOS,. SANITATION PERMIT Permit No. ....�..a_4_.__ 1�1 (Complete in Duplicate) � 1� Date Issued pplica+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------ _sI____. I�J Owner's Name _l-wY% Q---.`-- ------------------------------ ---------- ------ - ------------------------------------ ------ Phone--------------2-------_------_9- --4--4-- Address----------------- --------'--n------------------------------- Contractor's Name '----- -------------------------------------- -- ---- ------- Phone- -------- - Installation will serve: Residence 0; fApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __'_____ Number of bedrooms -7-.._ Number of baths A-_-_ Lot size r0C'1 +__ __ f___________ ____ Water Supply: Public system Community system E] Private E] Depth to Water Tabl __ ___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Q" Hardpan ❑ Previous Application Made: Yes ❑ No VNew Construction: Yes R2,'INo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta k; Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------- No. of compartments - ---------- -----------Size--------------------------------Liquid depth--------------- - --------Capacity----------------------- pisposal Fie d: Distance from nearest well.................Distance from foundation--------------------Distance to nearest lot line----.------------ C;4 Number of lines-----------------------------------Length of each line--------------------------.--.Width of french----------------------------------- T '� Type of filter material-------------------------Depth of filter material___- ...........Total length____________.__.__-____________________-__ Seepage Pit: Distance to nearest well_ _ -_.__-Distance from foundation_ .,__.Distance to nearest lot lir�r'-_.__.______ IK Number of pits._1---------------Lining material_A-_k r�i,�_____Size: Diam er.__3t:?._..._.._---Depth__._Z4_____________ ------- Cesspool: Distance from nearest well-------------_---Distance from foundation------------------- Lining material__._._------------------------------- (A ❑ Size: Diameter--------------------------------------Depth------------------------------------- ----------- --Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------- ----------Distance from nearest building------------------------------------------ ElDistance to nearest lot line__. -------------------------•-• ---------------------------------------------•---------------- Remodeling and/or repairing (describe)- V • 'tt`� T -.-----...-•--•-------------------------------•------------------------------•-----•------------------------------- --------- --------------------------- ------------------------ ------------------------------------------ •----------------------------------•--------•--------•----------•--•---------------•-•----- --------------------•-•--------•-•---•--------•-----------------------•----•--- I hereby certify that I have prepared this application and that the work will be done in accordance 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)-- .. /'-_'---------------------.......... (Plot plan, showing sizes of I , 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---'1 -------------•------------------------------------- BUILDINGPERMIT ISSUED------------ ---------------------------------- -------------------------------•-----•--------- DATE.--- ------------------------------ Alterations and/or recommendations:------------------ z_—rg--� -------•-- -------•----------------- --•-------------------------------------------------------------------- --- - ------------------- FINAL INSPECTION SY____ ____ _____ _ S . . -- Date �. SAN JO UIN 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 / . J E s--s 145446 AYWOOD +