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1� APPLICATION FOR SANITATION PERMIT y Permit No. (Complete in Duplicate) y Date Issued e Applica4lon 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- - ^- JOBADDRESS AND L C TON.i.... 7 .7---- --------------------------•--------------------------------------•---•------------ Phone------------------------------------ Owner's Name---------- ------------- y� - Address.. �� _ . -------- -•-•--- ------ . ---•----------------------------------------- Address... Name.-------- ---- ---- 4-- --------- -- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f ,Z_ �_---- r Number of living units: __/__ Number of-bedrooms _______ Number of baths _ __ Lot size __. Water Supply: Public system Community system [] Private E]- Depth to Water Table Y4--ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam E]— Clay Loam g '°Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No � New Construction: Yes 0 No g�— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) v Septic Tank: Distance from nearest weil__j istance from foundation-_-_f _____-.Mater- If__4�-.__'L_-_�_____�___-_—__� ----- 47 ___- No. of compartments----- ------------- --Size-, h_Xq-P-------Liquid depth__-- .--------.Capacity___ -- __-- �?-..__....Distance to nearest lot line--./ ._. � Disposal Field: � Distance from nearest wail-. ""Distanca from foundation_ � �ry Number of lines_____-__/___---_---- ----- Length of each line_-_-.---_-. -------- - Width of trench_.--vt_ ____.______________ Type of filter material_,/._ Depth of.filter material_-_..� ___--___-Total length____- __________________________ Seepage Pit: Distance to nearest well -_Distance from foundation__ ___-_-- i��anie to nearest lot hne__ .__________ Number of pits.._._ '_____________Lining materiaL _ .� "`--Size: Diameter__:;____.___------__--Deptn__.___.> P_--______-______ Cesspool: Distance from nearest well------------------Distance from foundation-----.-----____-.__.Lining material------------------------ O ❑ Size: Diameter---'--------------------------------- Dept h----------------------------------------------------Liquid Capacity------------------------•--gals. I Privy: Distance from nearest well------------------------------------- -----------Distance from nearest building----------------------------- - ------- ❑ Distance"to nearesf lot line---- --- -----------------------------•--------------------------------•------------- -------------------------------------•------------- -- ----------------------------------------------- ` Rem lin and or repairing {descrsl,e : -` --•--•------------------•--------- } - �{s... v-•.�,�� ------------------ -•--------------------------------------------------- ------------ ------------------•-•------------------------------------------------•------------------------------------------------------------- -------------------------------- ' ----------------- ------------------------------------------ -------- ----------------•-•-•--------------••-------•-----------•-••-------•--=---------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------------------- 4&---- --- - •�•c•�-'`�`"� -( _mulAw Contractor) By---------------------- --------- --- -- - - --- ----------------------------------= (Title (Plot plan, showing size of loth cation of system in relation to wells, buildings, etc., can be placed on reverse s' e) F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-- ---------------- ----- -- ----------------------------------- DATE--------- '"S�------------------------- REVIEWED BY----------- DATE ---------------•----------------------- BUILDING PERMIT ISSUED------------------------------ ------------ -- ---- ---------------- DATE Alterationsand/or recommendations----------=------------------------------ ---------------------------------------------•-------•-••--------------------------•---••-------------------•------- --- ------- Date rr 7 FINAL.,INSPECTION BY:----------- --- `----------------- - -- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT s 130 South American Streat 300 West Oak Street 132 Sycamore Street 814 North "C" Street y Stockton, California Lodi, California Manteca, California Tracy, California i -�s� - �asaas nTw000 k .:3