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APPLICATION FOR SANITATION PERMIT Permit No. _� (Complete in Duplicate) , t Date Issued �-� cos— ( 4'v-17 - Application is hereby made to the San Joaquin Local Health District for a permit to construct and install nk er This application,is made in compliance with County Ordinance No. 549. �: JOB ADDRESS ANDLOCATION---` '- ';,4 }s 'a S W� s Name, ° `-t,- � �. 4 Ph ' ----------------------- ------ ------------- ------ one Owner --�` �=� • �� ti-'w Address-------- r ----------------` ' '-- -------------- Contractors Name------------------- ------Yrs-Ar� ,Iv-------------- - -- ----------------- ------------ - -------------------------- Phone-•--------------•------ Installation will serve: Residence R Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ x Number of living units:"ft._._ Numkie�of bedrooms Number of baths _ - Uoi size ` Water Supply: Public system ❑ Community system ❑ Private [Z( Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 2..Adobe ❑ Hardpan-❑ �s f Previous Application Made: Yes ❑ No [� New Construction: Yes C}► No ❑ . �_t TYPE OF INSTALLATION AND SPECIFICATIONS: �l1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) "1 Septic Tank: Distance from nearest well--J--;k5------Distancce from foundation----J_U___------Material_____ .-_--_.-__ i ue No. of compartments------------- - ----------Size----l�--�--�--k$-- ---Liquid dept-------- - ---------Capacity----- --*-z Disposal Field: Distance from nearest well--1_S_Q--.--Distance from foundation------ a____._.Distance to nearest lot Ilne____ __..____. Number of lines----_-------` ------------------Length of each line---------- ©_`-----------Width of french-------V_V-------------------- Type of -Filter material___.____' ,---...Depth of filter material-----!__4_'.___---_-Total length___.4.O__- - Seepage Pit: Distance to nearest well.________________----Distance from foundation__________._.__.-..Distance to nearest lot cine .___.._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth----------- ------------- -._ Cesspool: Distance from nearest well---_-------------Distance from foundation-------------------Lining material_____--___________.__.._--.----------- El , Sizc: Diameter--------------------------- ---------`-Depth_---------------------------------- ---------.--Liquid Capacity--- --------------------*--gals. - Priv . .Distance_frornrnearest_well -' -,_- __+ :-- _-_ __{distance-from nearesTYbuildin - _----- - -- — El Distance to nbaresf lot line -------- --------- ---- ----- -_ Remodeling and/or repairing (describe)__________________________________ -------------------------------•------- ---•--------------------------------------------------------------------------- -------- -----•------------------------•------•--------•-----------------•---- -------------------------------------------•---------------------------------------------------------•------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County t ' ordinances, S ate laws, and rules and re ulatio s of the San Joaquin Local Health District. I Signed)---- = -------------------------------------------------------------- ------(Owner and/or ContractorBy:---••----------•------------------------------••------------------------------.------- ----------------------------- --------(Title)------- ----------- ` (Plot plan. showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side)- j FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY------- ---- -----��T ----------- DATE._ -��`i1.. � j ------------- REVIEWEDBY. ----------------------•------------------------------------------------------------------------------ -------------------------------------------- ----- DA. .-----•---------------- -- ----------- 'BUILDING-PERMIT•ISSU-Ep__:—�:--— ---------------- DATE..---- ------------•---- A terations and/or recommendations:-------........................ ...._________. _ -----•------------------------------------------------------------------------ .. _ ------------------------------------------ ---•----------- ------------------•---------------------------- --------------------- � . ---- ------------- --------------------•--------------------------------- ------- ---•-----------------------•------- ---------------------------- ---------------------------------------------------------- -� --- ---------------- - --------------------------------------------------------- , ----- -------------- --- --- ----- :- ------- --- --------------------------------------- -------- - -------- - ------ FINAL INSPECTIO ---- --- - --------�----------------- � .ate-. - ------------ 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 1 a —9-2M 10-52 Revised W-2100