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Permit No. ._:�-�--•�f--�-- �y�,rR APPLICATION FOR SANITATION PERMIT ►� �ka (Complete in Duplicate) Date Issued .._ -�---•- Applica`ion is hereby made to the San JoaquiA Loch Health District for a permit to co nstrue# and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN 111! ----•-----------•- - ----- - ------ ----------------- Owner s Name------ ------ ---- CJ - --------•----------------------------------•----------•-----• --------------------------- Address-- • ------- on �. ------------------------------------------------- Contractor ------------ Ph e Contractor's Name-----i--- •--------• ,,.� l MoteOther [IInstallation will serve: Residence Apartment House-E] Commercial E] Trailer Court C1 " ❑ o"� Number of baths .1---- Lot size _ �� ---/ ------ Number of living units: __�"- Number of bedrooms�`" --- Communit system ❑ Private ❑ Depth to Water Table -4a ft. Water Supply: Public system Y Y Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand [j Gravel ❑ Sandy Loam [I Clay Loam ❑ Clay ❑ Previous Application Made: Yes ❑ 'No Sa_ New Construction: Yes;Q_No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , ilable within 200 feet. (No septic tank or cesspool permitted if public sewer is avaf + Li uid de th tial _. --.---C��city--.- r Septic Tank: Distance from nearest 07i"istance from foundation__.- -- No. of compartments_------ ------..Size----- Q � q p Disposal Field: Distance from nearest well-W.4 -� istance from foundation___/-- -- -----•Distance to nearest lot lin I.16. --.- ench.----- 4C------------------- Number of lines-------:---/.......................Length of each line--------- --Q_. Width of tr o � R Depth of filter materal_.__�__ _____________Total length"____._ -_ Type of filter material__"-�-.�----,rte-a--'pP Al7-LL istance from oundation___--�"6-�Distance�to nearest lot line_*__J4-Seepage Pit: Distance to nearest well-___ l--- ---- � p ' �Z.�_____________".____ Number of pits----- --------- Lining materialWA_M"10- ize: Diameter_"_._tea-. ..:---.De tn'- E � _-._._._-_.____--.Lining material___._.____.._____._.-----------------. Cesspool: Distance from nearest well________________Distance from foundation. Liquid Capacity----------------------------gals, Size: Diameter------------------ ------------- ----Depth-------------------------- ------- ------------ ❑ Distance from nearest building------------------------------------------ Privy:. Distance from nearest wel4---------------------- --------- ----------------- ❑ � Distance to nearest lot ine._____------------------------------------- --- — U Remodeling and/or repairing {describe}:- -------•--------------------•-------- ------------------------------------------------ r ------•-- -------------------------------- - •---------------------------•------------ --- ------------ ---------- ------ ____________________________________________________________i_______.__.-------------------------------------------------------- . _______________________________________________________ I hereby certify that l have prepared this application and +hat the work will be done in accordance with San Joaquin County ordinances, Stat aws, and rules and regulations of the San Joaquin Local Health District. -----------------------------------{Owner and/or Contractor( Signed (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 DATE-------- APPLICATION ACCEPTED BY---------------- -------------- - •. --------------------- - - ------- - -------- -------- REVIEWED BY-------------------------- ....................... DATE------------ ... } - ----------- --•--- --------• DATE---- "------•"- ---'-�--��-------------- -------•------- BUILDING PERMIT ISSUED ---------------_----------- ---- Alterations and/or recommendations:_____________________ _ _ ---•---- --- ---••----------------- ----------- l't' ----.•------- - ------------------------- ------------------------------- ------------ ------- ` ----•----- --------- --------- Date----------------------- INSPECTION BY:------- - --- ---- --- ----------------- Date------------------•--- --- --- -----------f--------------------- f SAN JOAQUIN LOCAL HEALTH DISTRICT f132 Sycamore Street 814 North "C" Street 130 South American Street 30D West Oak Street Tracy, California Stockton, California Lodi, California Mentees, California , r5_9 145446 ATWOOD