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APPLICATION FOR SANITATION PERMIT Permit No. ........................ (Complete in Duplicated Data issued Applica"ion is hereby made to the San Joaquin Local Health District fo_r a.permit to construct and install the work herein described. + This application is made in compliance with County Ordinance Uo.:"544 l�� D34 2�" JOB ADDRESS AND LOCATION--_..-:- -►�c�--- --p --- --- �¢ ` o ,o a one ••---- Owner's Name-- _6.,_._r, -f=---------- ---- . . —_ Ph Address .................... - - c----- Contractor's Name------0-'L1- r--- f9 L 'Z �G�— ------------------------•--- Phone------------------------------ Installation will serve: Residence [t ' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units- ___/---- Number of bedrooms ._,.�. Number of baths __.L___ Lot size ----h_0----X--- 3t--------- --- ----------------•- Water Supply: Public system X] Community system ❑ Private ❑ Depth to Water Table _:��ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ *Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ .No a New Construction, Yes [& No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ Septic Tank: Distance from nearest Distance from foundation----Jd-----------Material----------- ------- No. :No. of compartm _l. __._��_--_- --.-._Capacity Y 9� Size9ilLiquiddepth-.-. . Disposal °¢ Field: Distance from nearest well.... Distance from foundation_.._-1�...........Distance to nearest lot line-___fid.-..__. Number of lines----------)--.-------- ----------Length of each line-----------�-�`- ------Width of trench--- 5� -------.-------__-- k 14 Type or filter material---�:�..-- Depth of filter material__-...1-�.�____--..Total length----------__._..__..._- •------ 47� Seepage Pit: Distance to nearest well...._Nh)- —__Distance from'° foundation-----�.1---------Distance to nearest lot iine,...� �...... Number of pits-------/-------------Lining material----e _1 cel�Size: Diameter-------e 1----------Depth------__--------------------- Cesspool: Distance from nearest well_---------------Distance from foundation--------------------Lining material__--- ----------------------------- Size: -----_.-._.--------._-_- -.Size: Diameter---- ----------------------------- Depth------- -- ------ --------.-Liquid Capacity---------------------------gals. j Privy: Distance from nearest well------------------------------------- ---- ---Distance from nearest building----------------------------------------- 171 Distance to nearest lot line-- -------------- -----------------------------------------------•-- ---------------- i 5 Remodeling and/or repairing (describe):_. ------------ ----••----------------•------------- ------------- ---------------------------------------•---------------------------- I --- -- -•--- 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 Contract BY� --- - --•--- L - ---------------------------------------------------------(Title)------ -'� (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 BY------- -------- ---------- DATE.-----�--------------------------------------- REVIEWEDBY-------------------------------- ------ ---- ---------- --------•----------------------------------------------- -------------D-- AT- -------------------- DATE �_...._ .....-----------...._.._......- BUILDING PERMIT ISSUED. ----- DATE------ ----- ------------------------- �1 •-_... Alterations and/or recommendations--------------------- ---_ ------- ------------------- ----• •.--------------- - c1i ----------- ------------ ----- FINAL INSPECTION $Y:.- ------ Date--------- -------------------------- ------ ---------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street "300 West Oak Street 132 Sycamore Street 814 North "C" Sfreef Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M 145446 nrwoo❑ 12-s4