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APPLICATION FOR SANITATION PERMIT Permit No. _V4 (Complete in Duplicate) Date Issued ..-._-__�..._._... Appfica4-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, f✓ E' r[J ��Q S E Gf L JOB ADDRESS AND LO IONJ.....t�Il .--- ! 1t��S��f'j� { ' - _ Owner's Name----- .. ? 5----------1 x.al--------------- ------ Address `3_ _ ....... ......s-` ----------_--•--------------- - ----------------------------------------------------------•------•--------------- Contractor s Name-----f/ _L -,----------------- ---•-------------------------------------- --•--- Phone.!1_ _4�4-�------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ....�_ Number of bedrooms -�__ Number of baths __ -Lot size _ Q f_____________________ Water Supply: Public system ❑ Community system [ rivate ❑ Depth to Water Table 13-7-0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe©Hardpan ❑ Previous Application Made: Yes ❑ No E4--New Construction: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__V0&/&'Distance from foundation----/D..r.....Material 9`1 No. of compartments...../...W_.Q--------size---:fa _._7.��_'Tiquid depth------- Capacity__F�q_4- ----- Disposal Field: Distance from nearest well-ZN,/0_L-Distance from foundation___?__0__'._.D)stance to nearest lot line`'--______. Number of lines-- 13 __.___Length of each line-A04- ;:,W.Vidth of trench------,� Type of filter material____.- __5 Depth of filter material__.1$.__.__..___Total length---Z_:. a__ ______________________ �o�t Distance from foundation__ C� fline �J Seepage Pit: Distance to nearest well_ . ____ c�___________Distance to nearest lot -__� � Number of pits------_;�---------Lining material__BL�±:4.Z'__.Size: Diameter.____;33.--..____Depth----.A!3—_ ------------------ Cesspool: Distance from nearest well_________________Distance from foundation....------- ----- Lining material_---------__________._._____--_____ ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------_--------_-------------Distance from nearest building------------------------------------------ ElDistance to nearest lot liner -------------------------------- -----------------• ---.......----------------,------------------------------------------------------- Remodeling and/or repairing Idescribe):------/N&!��---------l ! '� r ........... ..•-•--••--•----------•---------------•------------- ------------------------------------------------------------------------------------------ -------------------------------------------------- ----- --- - I hereby certify that I have prepared this application and that the work will be done accordance withSan Joaquin County-f-10 ordinances, Stat laws, and rules and regulations of the San Joaquin Local Health District. /� / •--5� ----.-- ` --___.__ --O er and/or Contractor (Signed)---.... -- -- - / 1 By:------- - ---- -------- -----------------------------(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 APPLICATION ACCEPTED BY--------- ---------------- -- ----------------- DATE-------- - ------------ --------------------------------- ---------------------------- REVIEWEDBY--------------------------------------------- ---------- `- -------- ------------------------------------- DATE---------------- BUILDING PERMIT ISSUED----_------- --- DATE----------- 4--------------------------------- Alterations and/or recommendations:__......________________ ____ ----.----------------�.-.-�- ___________ _ _____________ _:_____ __ ::_: .... .: -------------------__ --------_•---------------------------------------_---------------- �. ----------------------- ---------- --..` ....._------_--....-------.-...----------------------- - -- - - -------...-------._...-----------------------.-_--------- ------------ -------- -----_--.---_ -_ __ ________________________________...____.__...._ ._--- -__ ---.....__.______..______ . - - _ Q FINAL INSPECTION BY: ti. Date----f.�_ 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 Es9 145446 ATWODO