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APPLICATION FOR SANITATION PERMIT Permit .7.1-_q---- No _. - (Complete in Duplicate) // Date Issued ----_9._!-�l_lf� 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 L TION--------- .------ -- ---------------------- Owner's Name...------- ----_-------- -- ---- ------ Phone. e Address--------- .95 4.15-- - = .. Contractor's Name-------- ----- ------ ------- ----------------------------- •-------- Phone-j_a--6----91.�de Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel�❑ Other ❑ Number of living units: .--- Number of bedrooms --;?—.—Number of baths r/---- Lot size ------ -------.-- Water Supply: 'Public system jg--Community system ❑ Private ❑ Depth to Water Table a-n- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam [: Clay ❑ Aclobeja, Hardpan ❑ Previous Application Made: Yes ❑ No a. . New Construction: Yes No ❑ 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_- �Distance from foundation_ 1- .....Material..._C _1_�<��L.`�_.-. No. of Compartments____ _G__ Size__ ___X_R�Liquid depth=...._..r�_ ---Capacity_-_-19— 4�.-- Disposal Field: Distance from nearest well-. . _Distance from foundation. .__.-.-Distance to nearest lot line_-_� Number of lines-------------te �L_ength of each line._....�i_0... _ _ Width of french._____.�.�_:l,�!/ rr - j e tfr Total length "�'-------------- Type of filter materiaL___�..�-._.__'!�_/�.11 p h of filter -------- Seepage Pit: Distance to nearest well._A/.oP 1, Dista rQw fo dation--- ___.__.Distance to nearest lot line--._____ Number of pits-----/------------Lining mate iaL -___._ e�Di eter---.-_ ._„6epth..... ,"„ �.r-___..-- Cesspool: Distance from nearest well-----------------Dista from fou on---------------.----Lining material--- .-_-.-..-.-..__--__-__-_-_--. ❑ Size.: Diameter----------=------------------- --- Depth--------- --------------------------- -----Liquid Capacity-. .------------------------gals. Privy: Disfance from nearest well---------------------------------=-----------_-Distance from nearest building--------------------------.--------------. ❑ Distance to nearest lot line------------------------------------------------------------••-------- ----------- ------------- ------------ Remodeling and/or repairing (describe)--------- ------ ---------------- ------•---------------------•------•------------------------- ---•----------- -------- ' ------•----------------------•-•--------------•--------•-----------------------•-•-•----------- ------------•-•-----------._....--------------------------•---- ------ -----------..-------------••--- ---------------------- ---------•-------------------•----------------------------------------------------------------------------------------------------------------.------------------------------------------------------------------------------ ----------------- -----------------••-----------------••-------•--•------------•--------------------------------------------••-------------- ---------------------------------------------- -------------- C I hereby certify Cha ve prepared this application and that the work will be done in accordance with San Joaquin County { ordinances, State I , and les and regulations of the San Joaquin Local Health District. -- --- -- -------------------- - -- --------------------- --- (Signed)-------- ------- ----- � and/or Cantrac#or - / ----•----(Title)------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be 1.placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --- - - --- - ---- --------------------------- DATE ------------- --- ----------------------------i REVIEWED BY----- ----------------------- ----- -- --- ---- -------------------- ----------------------- ----------------------- DATE-----------}-----------...-------------------•----------... BUILDING PERMIT ISSUEQ._.. ------------- ------------------------------------------------ DATE ff Alterations and/or recommendations_________________ ----------------------------------------- -------------------------------------- ------------- ------------ ---- ----------------- --------------------- ---------------- -..._ (_ ------------- - - ------------- ___:_:_::_:_____ _ - ::�--- __:___- __ - -- ------ � ..::::.:... ..:.::....:::......:::. ::_ _---------------. - - --------------- -- FINAL INSPECTION $Y:.- Date---- I- - - -------- 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 Er-9 145446 ATwnao