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APPLICATION FOR SANITATION PERMIT Permit No, ... .G.._�.. (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. . JOB ADDRESS AND OC ION - ------S . . � 01 Owner's Name------ � . ..................... -• -- -----•-••-. ------------ - --------------•• ------ -------- P of---...................... Address.....I_.(.0 •---•-- ------------------ --- ---- Contractor's Name.......... --•-------------• -••---•--•-•-••---•••••----••-----------•-••-------•---------------------------------------...--••-•------_.. Pho ----•-••---•------------••------•- Installation will serve: Residence Apartment House F1Commercial Trailer 'Court ❑ Motel ❑ Other __ 141 ❑ Number of living units: -____ Number of bedrooms -__f_-_ Number of baths -_-�•__ Lot size ...._ ____/__o.. ..... Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Cla*' Adobe E] Hardpan F] Previous Application Made: Yes ❑ No &_ New Construction: Yes A No ❑ !F TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well7ishan e fro ou d - _ .__i.___ No. of compartments----- Size_. Liquid de th__ . _- --- ----- a act ___- .. Disposal �? Field- Distance from nearest well__/Q_4�0.Distance from foundation---IG1---------Distance to nearest lot li ---�_-. [� Number of lines......./...... _ n_Length of each line-----___�j.-�}........Width of trench.�.. _________________ \ yp )'a''4_ Depth of filter material-_--,1__L4_.-_ g T e of filter material. __._ ____ ......Total len th___1�_G7___________________________ Seepage Pit: Distance to nearest well_--------------------Distance from foundation-------------------- to nearest lot line................. ❑ Number of pits----------------------Lining material----------------------Size: Diameter-_.--------..-__..___Depth------.-_-_-_____•--._--.--_-___• Q Cesspool: Distance from nearest well-----------------Distance from foundation----.-------------- Lining material-------------------------------------- Size: _--_--_. __ .-_ ____-.Size: Diameter--------------------------------------Depth.----------------- ----- - -- ----Liquid Capacity------ .................gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ Distance _----.- .--•__-----•••_--_________-_.Distance to nearest lot line-------------'---------------•--------------- ...................................------------------------------:- -------•--•----•---•------- Remodeling and/or repairing (describe) ------------------------------------------I....... --•---------•----------•------•-----. ...---•-••••----•--•--- •-----.•-••- -•---•----•-•-••••-••---•---•-----•--------••---•-•-•- •--•............ ............. .•--•-------------------•----•-------------•------•---------------•-••------------w--•--•-----•-. --......................................................................... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat law , andules and regulations of the San Joaquin Local Health District. Owner and/or Contractor (Signed)-- -•----�---- ------ ------------�----------------- ------- --------- ------------- { / ) (:. By:---•..................... . ---------------------------------..----------.•. -•---.. -, -----(Title)-- -------- --- --------------------------------- (Plot --------(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 -- ------ .....7..' REVIEWED BY------------------------------------------------------- ----- --�'--�,,.� .......................... DATE.----•--- �.. �.�_.__....------------ BUILDING PERMIT ISSUED............................ .. Alterationsand/or recommendations-------------- ------------ ---------------_-----_--•-------------------------------------------•--------------•------•-----•••......--•---------------•--- -------------------- ------------------ ----------•_.._...------•-----------------•-----------------••---...-••-••-•------------------••--••-•••-•--•--•-••••-•--- •••--•--...--•-----••--••--•-............-----••-•-•- ------------------------------------- --------------------------- ---------•------------------------------------•-----------------------------------------------•----------- --..._...............--•••-----..........----- - FINAL INSPECTION BY:. _... •... --- Date --"!_---_ .....-. _ ----- ---------•------------ 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 ES-9' - 145446 ATWOOO