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S V L 5 , APPLICATION FOR SANITATION PERMIT Permit No. -------------- -------- (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 comp'ance with lounnf Ordinance No. 549. ADDRESS AN LOCATION- G � ----- ---------•--------- JOB r 1 Owner's Name. '1.�4. .� Phone... j '' -------•----• -----•------------•-------•--- -- -------------------- AddreAddress-. ss----•----------•--- --�--�-•------------------ Contractor's Name------ ; -------------------= -----------•------------ --------------- Phone-------------------------- I Installation will serve: Residence Apartment Hause ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ I Number of living units: J---- Number of bedroomsNumber of baths "- -"-- Lot size -- "" --- -- - --- \4F Water Supply: Public system ',Community system ❑Private E3 Depth to Water Table --"____ ft: Character of soil to a depth of 3 feet: .Sand ❑ ' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobegHardpan ❑ kr Previous Application Made: Yes F1No`Z.L New Construction:YYesNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ' �. - •- ' Septic Tank: Distance from nearest well�'�t..��Distance from foundation_1--"Q..._.--_---.Material_________________ __ ------- Ca acit > l `�f No. of compartments-'-'-. ---------Size___ Liquid depth------ P Y r " ---------' p I n th of each line--- -C�---'��-----.Width of trench---� t Eine----- ••----- Number of lines------.- .. --- g ` Dis osal Field: Distance from nearest well___ a . stance from foundation___._ _(_.__....Distance to nearest o # Type of filter material epth of filter,.material.....__�.g----------Total length_____a__- Q-"----"""_---------•---- Seepage Pit: Distance to nearest well-_--..._"---__---"--__Distance�fsom foundation-------------------Distaste to nearest lot line------ __.___... Number of pits----------------------Lining material----- ------.Size: Diameter---------' - Depth--------------------------' Cesspool: Distance from:nearest well-----------------Distance from foundation._ --.--..Lining material---------- "___________ ❑ Size: Diameter--------- ------------------------- Depth"--------------------•------ ----------------------Liquid Capacity-------------------------=:gals. -privy: Distance frominearest well"-------------------------------------- ----------Distance from nearest building-------.__.__.____-____--------------' ❑ Distance to nearest lot line----------------------------------- -' Remo eling and/or repair-i (describe}:_-- t -- -------- -4 �- ------ --------------------•---'•------- .,. `.. ------------------------- -----------------• - ----------------••-- ----------- --------------------------- ---- --------------------- I hereby certify that 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. F. G ��-�---.--=a'�---- � �'�''�---- ----" - (Owner and/or Contractor) (Signed) - BY� I ---------------------------------- - (Title) - -----•------ --- --- --- - (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 I APPLICATION 'ACCEPTED BY----- ------------------ DATE �- ----------------- APPLICATION _ REVIEWED BY <;!� •-------- DATE--.-- BUILDING PERMIT ISSUED-------------------------------- ---------------- DATE------- ' fin--- ------------------------------ Alterations and/or re mmendations: - 46 ----- ----- Q Ro1�. w L -------------- -= - ----- - . -- . --------------- ` c�-:- Vii._"�:-�-✓ =�-��_- zzi ---�--►�,_:�..�__ _ -. - - - - ---- .r to --- ------------------------------------ ------------------------- ---------- � FINAL NSPECTION BY:..:4---i = --- - ---•--- -- _ �.w SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Streef 300 West Oak Street 132 Sycamore Street 814 North "C" Sfreet Stockton, California Lodi, California Manteca, California Tracy, California