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APPLICATION FOR SANITATION PERMIT Permit No _ __ l� (Complete in Duplicate) y 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. JOB ADDRESS AND LOCATION-' Owner's Name--- -,,��//��_� -----------------•-- /l-�44v.C' �'-SIC Address--------- -- --- --------------- - ------ Phone_ --*-------------- ----••---------------- -------•--•--------------•------- ontractor's Name________ __ _ __ ��- _e-:•-------•---------------------------- ----------------------- ------------- ------- -- ------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Number of living units: -"I--- Number of bedrooms ❑ Other ❑ Number of baths __/--- Lot size ____ -_�_-iX_ �(�� Water Supply: Publics stem Y ❑ Communitysystem � p ----"------"""""""'--'---"`- Character of soil to a depth of 3 feet: Sand Y Gravel Private LoaDe Depth to Water'Table--------- ft. ❑ ❑ Y ❑ Clay Loam ❑ Clay Previous Application Made: Yes No X ❑ .Adobe Hardpan ❑ ❑ New Construction; Yes Na ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 206 et.) Septic Tank: Distance from nearest well__,__._____-----Distance-from ifound tion"-/� T No. of compartments___ _ a Material_ C Size_ t - - -"--Liquid depth_"--- Ca acit Disposal Field: Distance from nearest wel!__777=+ �° --- ----- p y Distance from foundatio ._..--_-Distance to nearest lot line--- _..__._._ Number of lines-------Z_—_ Length of each line_______. si Width of trench.----, "-- - Type of filter material___— + --"Depth of filter material._.f` ------ t' ------.Total length_-_._-/-_D__�_- Seepage Pit: Distance to nearest welL._"' ---Distance from foundation---Ir_; -____- -- Distance to nearest loft line------------------- Cesspool: Distance from.Number of pits-------------------"--Lining material---�------------_--"--.Size: Diameter_----""----- ---- ----Depth------------------------- - , nearest well___--"-"---- Distance from foundation_ _ _"-__--- ...Lining material ❑ Size: Diameter._._ -.- "-- '" 1 - ---------Depth------ -- ---- - ----- --- -----Liquid Capacity_ gals. V a - - Privy: Distance from nearest well._. -."_ `----" ---------------------------.-_.__._Distance from nearest building " ❑ Distance to nearest lot line___ 9 --- _____________" ------------------ #----------- Remodeling and/or repairing (descriL�e)i : "--4- - r .---- x -- -- ------ ----•--------------------------------------------------------" -----•----- ------------------------------------------- - e 1 ! hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County 1' ordinances, �SSt�ta__te laws, and rules and regulations of the San Joaquin Local Health District. (Signed)...l �j ,. •� _ [Owner C By:-- °' - - ----- T if rand/or Contractor) (Plot plan, showing size of lot, location of system in�relafion to wells, buildings, etc., can be place on reverse.'"side). ; t FOR DEPARTMENT USE ONLY �r APPLICATION ACCEPTED BY--------------__: REVIEWED BY DATE --------------------- -------- - - U BUILDING PERMIT ISSUED ` DATE- ------- - ---- ---- •---- Alterations end/or recommendations:_ - DATE__._________ --- F1NAL INSPECTION BY:- -.." :_,--_-- _ r` '"" �.. Date. +CQ r_-)...... _-_ -�---------------------------- --•------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wesf Oak Street Stockton, California i Sycamore Street 814 North "C" $}rae} Lodi, California Manteca. nteca, California Tracy, California En—`3 145446 ATWOnO