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Permit APPLICATION FOR SANITATION PERMIT °-- - ' (Complete in Duplicate) - f 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. /3,0 - 7 .. JOB`ADDRESS AND LO A ION----- - ----JQ_d- -e-____GL ---- -- -- /YQ---. ---- -- .�Q-z.- Owner's Name------ d ------- cam•'-�.oti A //Phone-------------------------- ------- Address..... C.. ----------- ------------------- ---------------------------••---••---------..------------•-_------- Contractor's Name-------- ---- -------------- — `'"` `"`--- --------------------------------------------------------- Phone- ---z-- f �7 Installation will serve: Residence VL_,�partment House [_1 Commercial ❑ Trailer Court ❑ Motel L] Other ❑ Number of living units:/..____ Number'of bedrooms _: Number of baths_____ Lot size _____.__� _ :.._ ----------------- Water Supply: Public system ❑ Community system ❑ 'Private V}`Depth to Water'Table _ .'.�` ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R Hardpan ❑ Previous Application Made: Yes ❑!i No 2- New Construction: Yes g�_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: e�__Distance from nearest well-----------------Distance from foundation--------------------Material _.--__--.-_.-__--.-..._----_----_---_-__-_-_-_-. ❑ �o. of compartments------- -- ------------Size---------- -------Liquid depth--------------------------Capacity-•---------------- Disposal Field: Distance from nearest'well------ -------Distance from foundation--------------------Distance to nearest lot line-----_--_--_----- ❑ umber of.lines-m----------------------- ---------------Length of each line------------.-.---- -.----.Width of trench----------------------------------- ype of filter material-------------------------Depth of filter material---..---.-_________..Total length_-_----_.---_-_-..--.-__-__-------___.._.- -� Seepage Pit: Distance to nearest well_. r 9___---Distance frogs foundation- 7��._.___.Dista nce to nearest lot�yline__1�---- Number of pits.-/-.--..............Lining material.-.- --�_ ``e5 : Diameter___.___=5----Depth-_---ZZ_c� ------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------------- Lining material __.--_--___-;-_---.-_.:----------._-. ❑ Size: Diameter_- q---------------------------------Depth---------------------------- - ----- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-__-...__-_-.__-____-_.--•___-_.-----.-. ❑ Distance to nearest lot line-------------------------------------------- ---------------------------------------------- •---•---------------------------------------- h Remodelingand/or repairing (describe)-------------------------------------- --------------••-•-----•-•-----------------------------•------------------------------------------------------- ------------------------•------------------------•----------------------------------- ----------------------------------------• •------------------------•------------------------------------------------------------------- I -------------------------------------------------------------------••-------------------------------------------------------------L------------------------------------------------------------------------------------------- -------------------------------------- ------•----------------------------------------------------------...---------------------------------------•--------------------------------------------------------------------- I hereby certify that I have prepared this application and this+ the work will be done in accordance with San Joaquin County ordinances, Stat - - -------- -------and rules and regulations of the San Joaquin Local Health District. (Signed) Y� �- ---------------'--`-------------------------------------- (O ser and/or Contractor) By- - -- ------ -- ---- _-------------- (Ti+le)------ ------------------------------- --------- (Plot plan, showing -size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).- F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY. - -------------------- ------------------ DATE-----�-------------- ----------------------------- REVIEWEDBY------- ------------ ------ ----------- ----- - --- ---- - --------- DATE BUILDINGPERMIT ISSUED--------------------------------- '-------------------------------------------------------- DATE------------ C -------------------------------------- Alterations.and/or recommendations-------------------N- --------------------------•---------------------•---- £� ................:......... . I< --- ---------------------------------------------------------- ----- , FINAL INSPECTION BY: [y+ ..!4�.� Date--- � �� ~'S -------- - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California 1 Lodi, California Manteca, California Tracy, California Es--9 145446 Arwnno