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r APPLICATION FOR SANITATION PERMIT Permit No (Complete in Duplicate) " Date Issued Applica+ion is hereby ma o the San Joaquin Local Health District for a per it t construct and install the work herein described. This application is a in co pl• e y Ordinance No. 547. JOB ADDRESS AND L ATION - ----------- -- --------- ---------- Owner's --------Owner's Name -----•-- ------ . ... - ------- Phone-------------------- --- Address----_...•--------- Contractor's Name-- -- --- Q.v Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms;,_-_ Number of baths --�-- Lot size ---l_17__.----/-�{/-------------------- f Water Supply: Public system ❑ Community system R�-�rivate ❑ Depth to Water Table/(r ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeFlardpai i Previous Application Made: Yes ❑ No gr New Construction: Yes 9�l 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-_)h —Distance from foundation._./40_"_._..Material__.d_.a_- .__..___F ' No. of compartments_.__A------------------Size._,,xfA_Jf_yQ-------Liquid depth_.__ _ '�y�. -----------Capacity-, Disposal Field: Distance from nearest Distance from foundation___ ---------Distance to nearest to i "~ Number of lines------- Length of each line----19 _________________Width of trench___ Type of filter materiaL/ -Depth of filter material___ �----Total length-------- Seeps Pit: Distance to nearest well_._ ice_-Distance from foun ation-l�_____.__.Disfaoce to-near-e- ----------- D o near-e i r ----------- [� Number of pits_ --sq------------ mafer�alG_C__ __._____..Size: Diamefer.. --..___..___Dept Cesspool: Distance from nearest well--------------___Distance from foundation------------------- Lining materia ----------------- ❑ Size: Diameter------ ----------------------------•--Depth.---------------------------------------------------Liquid Capa g Privy: Distance from nearest well _________________.____._----__---.-------------Distance from nearest building ❑ Distance to nearest lot fine- ------- ------------------ Remodeling and/or repairing (describe):--------- --- - --- - - - --- -----•-----•.:------------------------- -------------•----------- w -------------------------------------------------------------------•---•--------•--•---------•--------------------•---••----------------------•------------•------------------------ ----- I ---- ------------------------------••------------------------------••-•----------------------•-•-----•----•--•-------------------------------•------------------------`-------------------------------•-------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co tY ordinances, Sfafe laws, and rules and regulations.of the San Joaquin Local Health District. (Signed) ,-.__ _ -=------ --------(�` r Contracto BY: ---= --------------------------- ----- 'Ir J--------•------ ---------------(Ti+le)------ -- --------- (Plot plan, showing sae of lot, to ion of system in relation to wells, buildings, etc., can be placed on reverse sid FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------< _ DATE_--- - ---- ----------------- -- ------- ------------------------•- ----------- REVIEWEDBY--------------------------------------------- - -��-------------------------------------•------------------------ DATE------•-----" „ ,,,r-•------•------------•-------------- �, BUILDING PERMIT ISSUED ------------- ' ------ DATE.----- -- --• --- Alterations and/or recommendations: C �i - ----------------- _ ------------ _ _ v ------------------------------------------ ------------------------------ ------ --------------------------------------------------------------------- --------------------------------------------•-------- FINAL INSPECTION BY:..... ------------ --------------------- Date---_.--a-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street r. Stockton, California Lodi, California Manteca, California Tracy, California ES-9 145446 g7WODO