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APPLICATION FOR SANITATION PERMIT Permit (Complete in Duplicate) Date Issued """ 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. dcs ---------------- JOB ADDRESS JANILOCATION - 7 ----------- ------ � " . Owner`s Name- -------------- ---------- ------ ------ Phone------------------------•-----••---- _ Address---------, T--------j— --------`� Z ." �_' ....-------•--------------- ..� 7 - --------------------------- ----T ----------- ------------ Phone_1 Contractor's Name_.""_.: - - 6 ------- Installation will serve: Residence �partment House E] Commercial ❑ Trailer Court ❑ Motet 01 F] Other ❑ Number of living units: __ _" Number of bedrooms _"-_�Fumber of baths ._"�__ Lot size ---7v.__--"_- -- a-A--------------- Water Supply: Public system Community system F1Private E] Depth to Water Table _--_._"_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[g--Hardpan E] Previous Application Made: Yes ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if.public sewer is available within 200 feet.) Septic Txk- Distance from nearest well------------------Distance from foundation--------------------Material------------.---_--------------_--___-.-.--_-._. ❑ �)(� i�t`No. of compartments-------- ---- -----•----Size--------------------------------Liquid depth-----.--------------------Capacity-------------------- Disposal Field: l Qistance from nearest well-----------------Distance from foundation"---"""" """....".Qistance to nearest lot line"__"""-_."""___". ❑�X's�'7�fNumber of lines-----------------------------------Length of each line-----------------------`------:Width of trench---------------------------------- // Type of filter material-------------------------Depth of filter material---------------------Notal length------------------------.-------------•i Seepage Pit: Distance to nearest weIL. 6 9Distance f,rQ�r foundation___.a DistanEe to nearest lot line-_-- d-_-- Number of pits--------1-----------Lining material--- _r"�r4Sizt;: Diameter------�"---------Depth....- - -------------- Cesspool: Distance from nearest well--------------" Distance from foundation.--__------r-------Lining material-----------------.----__------------. % ❑ Size: Diameter---- -------- -„-------------=----- Depth------------ - ------•--------------------- Liquid Capacity gals. t.. Privy: Distance from' nearest well-------------------------------------------------Distance from nearest building--------------------------------------- -- ❑ Distance to nearest to#'line-------- ------- ----------------------------------------------------w----Jif•------------ --------------- - ------------- ---------- 6 N"-• --------- Remodeling and/or repairing (descfibe):--__- alb` = --- --- ---------------- --------------•.-..-•------------------------------. i _ S ------------" -”- " .-.-" -.-" ------------------------- - -----' ------•---j----•._`--•-•-----------------`^-------_---""""-----------""""---'----•-------------..""""."""_-."""""__"_"""""..""_"""__-----------_."-.-"-""""-"__""""--"..."_-- I hereby certify that I have prepared this application and that the work will be done in.accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. . pp Li Ale ( ner and/or Contractor) (Signed)-_. n 1 `�------------ . I ) ---------------------- _ � _ - - (Ti+a .----- - ---- ---- By: {Plot plan, showing sire of lot, location of system in relafion to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE----- ----------_V- APPLICATION ACCEPTED BY - REVIEWED BY------------------------------- ------ ---- ------------------ DATE----- BUILDING PERMIT ISSUED------------------------ --- DATE-------------------•--------------------------------------- Alterations and/or recommendations:------------------------- -------------------------------------------•------------------ _... ------------------ FINAL INSPECTION BY--------------------- -•--- -- - " Date------ 1- ----- ---------------------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT # 300 West Oak Street 132 Sycamore Street 014 North "C" Street 130 South Americbn Street a Trac California Stockton, California Lodi, California Manteca, California Y. ES J--2M 145446 ATWOOP 12.54