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APPLICATIQ,-F-0 SANITATION PERMIT Permit No. ."" �-t... (Complete in Duplicate) Date Issued .""4f- -_---I ."" Applical-ion is hereby made to the San Joaquin Local Health District for a permit t construct and install the work herein described. This application is made in compliance with County Ordinance No. 5 E *I ; JOB ADDRESS AND •ATION------------ --- "" - -- -,r-. Phone----- Owner s Name. T Address------------- - �'-��•---�•�_.�' ��t,!!'^�'`.:----------•----•--•-------- . ---- - Contractor's Name. �------�- --------- ------ ---- Phone._ h 1lpQ ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _"" Number of bedrooms __/. Number of baths ---/-- Lot size ---- --e-----.A-----�- ----•------- Number of living units: -_/Water Supply: Public system 0.—Community system ❑ Private ❑ Depth to Water Table _'04>ft. Character of soil to a depth Qf 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe jq- r. ari ❑ Previous Application Made: Yes ❑ No gNew Construction: Yes 01- No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 2U0 feet.) 4 .� �-�-�----.Material-----� �--�--' Septic Tank: Distance from nearest well__,.�u rstance from foundation--- - No. of compartments -- Size---- --- -U-.Liquid depth.---�.- ".".---Capacity.-- ----------- � �. �-- --- AV r_.Distance to nearest lot line- -..- Disposal Field: Distance from nearest wet{ or ---k1G...��tance from foundation--- Width of trench-_-. Len Length of each line "AV �f.......... Number of lines---------- ". _ g rf'-- --rt" Type of filter maternal__/�---..-Depth of filter material-- $_-----Notal length--"._ ------- Distance to nearest lot line Seepage Pit: Distance to nearest well-.__&TW_,Distance f o foundat41 ion---- "-----._--."_. �, . . ., ____. Number of pits._- .-._"-..- --Lining material- . -__"--_ z� Diameter------ Depth.--. f:d, Cesspool: Distance from nearest well----------------- from foundation-_-.----------------Lining material---------_-----____,-=.__-_.--._-_---. Size: Diameter----------------------- ------------Depth-------------- Liquid Capacity gals. \ ❑ ---------- i Privy: Distance from nearest well--- ------------------------------------------ --Distance from nearest building-------------_---_.--_---__--------------- ❑ Distance to nearest lot 1ine------------------------------------- ----------------------------•---------------------------------------- Remodeling and/or repairing (describe}----------------------------------------"--------•------•----------------•-------- -"-- ------•--•--•-----------------•--•------_------------------------- �Ll ---------------------------- ----------------------•----------------------------------------------------••----•----------------------------------- ----•----------- --------------•---------- -------•-- ------ ` ---- ---------•-----•------------------•------•------------------------•-------•-------------•------ .. I hereby certify I ha prepared this application and that the work will be done in accordance with San Joaquin County Y ordinances, Stat ws, a ales and regulations of the San Joaquin Local Health District. 1. F � y? i-��r and/or Contractor) -- By:.-" -----------(Title)---- x---�--------- -------------- (Plot plan, showing size of lot, location of system in relal•ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- - --- -- DATE...... ----------------------------------------------- .REVIEWED ----• ------------ 'REVIEWED BY----------------------------------------- ------- -- ----- ---- ---------- ----------------- ---------------- -------- DATE---------- -------------- ------- P. ------ - - BUILDING PERMIT ISSUED----'----------------------- ---- DATE---------- ----- ------------------ ------------"-----•----------- .."-....- ,-i ---•---- ----------------- ------ Alterations and/or rec4l----ommendations:. ------------- --------------- -------------------------------- .- .-- . ". -- ------------x . R ---- - - --------------- --------"""-------------•---- f_�lZk ,. . _ -"d - r•' --r -------------- e _ FINAL INSPECTION BY---------------- Date----------- -------------------1---------- --------------------------- ----•--- ----------------------------------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT p 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street ' Stockton, California Lodi, California Manteca, California Tracy, California E$ 145446 ATWCuO .. -