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i APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued __-.- .�- p pp ocalication is hereby made to the San Joaquin Ll Health District for a permit to construct and install the work herein described. l • This application is made in compliance with County Ordinance No. 549. JOB ADDRESS A D LOCATION. _._- !_._- •.-. =- -------------------------------------- Owner s Name--------•--'----------------• '�° '�---------- •-------------------- Phone-.2 - �� Address-....9�1 ---- --••-------------- Contractor's Name------ -------------- Phone 3__i:�a-� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court 0 Motel 0 /Other Mf Number of living units: ------ Number of bedrooms ---__._ Number of baths -c?-- Lot size ._._l_o a -/-- ' ---------------------- Water Supply: Public system Community system ❑ Private❑- Depth to Water Table-yd-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeN Hardpan ❑ Previous Application Made: Yes E] No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet. i Septic Tank: Distance from nearest well++/v4 �{'Distance from foundation-lQ----- ___.Material-----------------------------------_--..---- -./�� t ------Ca acit G-�9 "--- No. No. of compartments-.-. -- -- _ - -- p Y --- �r � - - ---------Size.S6��C-tl��_Sl,,�-Liquid dep#h--------Jam------- �yLl A Disposal Field: Distance from nearest w el% Distgance from foundation--20_..-----...Distance to nearest lot line-------- lines ------- -- --- Number of lines-------------- --- Len th of each line------- ------- ------ -Width of trench------A�-`-y- -------------------- Type of filter mate rial-.45!�_�_,rA-__--Depth of filter material':./�_�-__-----Total length---------3a-- ----------------� -- Seepage Pit: Distance to nearest welt/_�_ Distance from foundation__- p_�_._..Distance to nearest lot line-.. 4--.__-- G Depth.---- ---------------- - Number of pits......r'-------------Lining material_.Size- Diameter------- ..-... _.---- � Kr Cesspool: Distance from nearest well-----------------Distance from foundation-...- Lining materi al-------------------------------------- ' ❑ Size: Diameter------ ----------- -- ----------------Depth.---------------------------- ------- ------------- Liquid Capacity. {gals. - I � Priv Distance from nearest well.-----_-...__-----------------------------------Distance from nearest building_ ------------------------ Y ❑ ------------------------------------- Distance #o nearest of ine-------------------------------------------------------- Remodeling and/or repairing (describe)---------------------------------------t----------•-------- --------------- '•-------------------------------•-------------------------------. ,f. ..........r--------------------------------------------------- --- --------------------------•--------------------------------•--------------------------------- = --------------•----------------------•--•-------------------------------------- M ------------ - -----------------------------------------------------------•--•-------------'--------------I---------------------------------------------------------------------------:---------------------------___--------- i ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Cou ordinances, State laws, and rules and regulations of the San Joaquin Local Health ¢ ` " District. .�.:.(O v. fner and/or Contractor)r-------------------------(Signed) ---------� ` � By:------_---- - € ------------------------------•------------------------------ (Title)._- (Plot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). R D PA TMENT USE ONLY f APPLICATION ACCEPTED BY--------------------- -- -------------------------- f :. ------------I ATE �--------- ---- REVIEWED BY------------------------ -- ATE BUILDINGPERMIT ISSUED-----••----------------------------- ------------• TE------------------------------------------------------------ Alterations and/or recommendations:------- -------------------------------------------- --------------------------------------------------- --------------------- ------.. ------------ -------------------------•------ ------------------------------------------------- ---------------------- ` -- -0 ` )- I - 0 l/ 7� - ---- ---------------- Date-------- - --- -- -------------- -------------------------------------- FINAL INSPECTION BY:-----�{-'-..:... „__ �. �? 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 ES-4-2M 10-52 Revised W-2100