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APPLICATION FOR SANITATION PERMITPermit No. .. _ 7_---/d--• L i, I [ (Complete in Duplicate) Date Issued Applica{ion is hereby made to the San Joaquin Local Health Di rict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance o. 549. JOB ADDRESS AND CAT( N a •---------------- --- Owner's Name. - --------------------- ------- ---- Phone. _. 1 -------- Address ` --------------------------------------•--------- :._. Contractor's Name- .......... ------------- ------------ --------- --------- --- --------- ------------ Phone_---- -7;,1 � Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units:l_____ Number of bedrooms 2._ Number of baths ._/___ Lot size - - X- ----------------------- Water Supply: Public system ❑ Community system ❑ PrivateX Depth to Water Tabl@/�_�ft. Clay El Adob Character of soil to a depth of 3 feet: Sand E] Gravel El Sandy `Loam El Clay Loam❑ eHardpan ❑ , Previous Application Made: Yes ❑ No New Construction: Yes No ❑ / \� , TYPE OF INSTALLATION AND SPECT (CATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic anka Distance from nearest well_________________Distance from foundation__-_________--_.-_.Material------._____-_________--__________-__.-.--.____. No. of compartments---- - ------------------Size_•--•---------------------------Liquid depth---------------------------Capacity------------------ ---- �__-___-_-Distance to nearest lot line________________ pisposal field: Distance from nearest welL_�U_�._.-_Distance from foundation_`.-__/ Number of lines-------/----------- ---- -------Length of each line--- --- -i- Width of trench--- --�-------------------- Type of filter materia- __ _-_Depth of filter material.../ --------------Total length_______ � ______________________ Seepage Pit: Distance to nearest well_____________ ______Distance from foundation___--______________Distance to nearest lot line----------------- ❑ Number of pits---------------- Lining 'material-----------------------Size: Diameter------------------------Depth------- -------------------------- Cesspool: Distance from nearest well----------------_Distance from foundation________________ Lining material-____..___--____________________-_-_ p ❑ Size: Diameter--------------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------_-------------------Distance from nearest building --------. +' ❑ Distance to nearest lot line- ------------ ------------ - -.------- P Remodel' repairing (describe: ti= �-��` ` - ----------- --- ------------------ ---•--------------------------------------------------------------------------------------------------------------•----------------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a law , a rules and regulations of the San Joaquin Lcmal Health District. -- •--------------------------- ----------------------------- --- ------------------ = {Owner and/or Contractor (Signed)--- ---- �--- - �. - ,--------------------------(Title)-- ------ - ------ ------------------- -------- By:___---------- ----- - -------------- relation plan, showing size of to+, location of system in relation to wells, buildings, etc., can be pace on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------- ----- --------------------------- ------------------------------------ --------------- DATE-•------------------------_-- ----------------------------- REVIEW,EDl BY-------------------------- DATE BUILDINGPERMIT 'SSU D----•••------------------- ----------------------- --------------------------------------------------- DATE-------- � . Alter tioc .and/or reco mendations: - I $ '� ------ ---- ---------- ------- ------- =- -_- --4------- ---------------------�` IKA --------- -- ----------- ------------ -------- ---------------------... --------- i - - FINALINSPECTION BY:----------.--------------------------------M-------- ---------• Date------ ------ -------------------------- ---------------------------•------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American.Street 300 West Oak Street ! Sycempre Street 814 North "C" Street Stockton, Californid' Lodi, California Mantaea, California Tracy, California x ••�i�E!; 9t 2M-i..•'i 45446 arW000 „F 12-54