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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Permit No.Q:5-. //" Date •Issued' -=c` Applicaa-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. r JOB ADDRESS AND LOCATION--------- ------�/:4_+/�,P-.,4--,--------------------------------------------- ----------------------•---•------------ P j Owner's Name------ ------------ - : - -------Phone------------------------- ---------- Address ------- --- - Address------- -/- ------ : ��. ` 1-----•-------------------------=----------------------------------------------- ----------------------------- -_ --- r ----- -- -- -- ----------------------------------------------'---------- Contractor's Name.. _ i ---'--�-i---••rl--- - - - ----- - --- - �------------------------------------------------------------ Phone. j/0"_�----��---1°--°--7-- Installation will serve'- Residence Apartment House ❑ Commercial [❑ Trailer Courf ❑ Motel ❑ Other ❑ Number of living units :-------- Number of bedrooms _- Number of baths -- -__ Lot size -- ------------ _.-.-----------_----__-_--------_-_-_._----_ Water Supply: Public .'system ❑ Community system -EI Private ❑ Depth to Water Table -------- ft. . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe Qj Hardpan ❑ Previous Application Made: Yes ❑ No OP New Construction: Yes Do 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 ---- j_! ---------- Material ---- e- _._ _.- --------------- No'. ---------_. No. of com artments_----- .�----- Size_Liquid de th_----_-�� Ca aci GO9exU / Disposal Field: Distance from nearest well___.."?-- ........ Distance from foundation---- 0-' __---.Distance to nearest lot lire----------------- Number of lines ----- --------7 ------ I------------- Length of each line ----------- 1��-------------Width of trench-----'a-�--------- ------------- Q Type of filter material-----_�_T-A&V(/Depth of filter material- __-1g.--__._---.Total length ------ fd--------------------"---___-.- Seepage Pit: Distance to nearest well ---------- from f urkdation---- cZ-5--------- Distancg to nearest lot liner---- 91 Number of.pits--- .--..1 ------------ Lining material ----ems-_ Sze: Diameter------3-�:------Depth-----IR.5---•-----------•-_- Cesspool: Distance from nearest well ------------- ---Distance from foundation ------------------ ..Lining material --.-------_-----_--------.__--- ❑ Size: Diameter-------- ------=---:----------------Death--------------------------------------------------- Liquid Capacity ---------------------------- gals. Privy: Distance fromdnearest well. ----------------------------------- Distance from nearest building.---------------------------------------. ❑ 7 Distance to nearest lot lire ----------------- --------- -- - , 1 Remodeling and/or repairing (describej:----------------------------------------------------------------------------------------------------------------- •----------------------------------- - a I � s r _ r ----------------- I hereby certify fhiat 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. 4 (Signed)---- ------ ------------ • - - -- ---------------------------------------------------------=----{Owner and/or Contractor) By:'-�� "''- (Title) .... F ------------- (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----------- REVIEWEDBY ------------------------------------------------------ --------------------------------------------------------------------- DATE-----------= --------------------------------------- 13LIILDING PERMIT ISSUED ------------------------------------------ DATE------------------------lj?J•---------------------------- L Alterations ----------------- --- Alterations and/or recommendations:--.-----• __ _ •-•-----•-------••--•----•--------------•----•--•-----••---------•----- -- _ .�P - -......�...------------------ ------- ---- ---- ------- --- -I- _-------------------- ------------ ----- -------------------------- - ,- --------- ---- --------- - •--------I---------•---------------- ----------------------------- • -------------------------- FINAL INSPECTION Date. ----------- 1•• ------ 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 6-9-2M Revised W -210D