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jv- �- APPLICATION FOR SANITATION PERMIT Permit No. .__-.---_---_L__-•-- (Complete in Duplicate) Date Issued --_./_______/__.�' Applica+ion is hereby made to the Sa 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 ANDL AT10 , k .::: -- ------------- Owner's Name. ' -----. Phone__ ----------------------- ,,ry Address �l �� '----------------------- --------------------------------------------••--••------------------ Contractor's Name------------------- -- -- ----- ----- ------------...__ ---------------------- Phone------------I——--------------- Installation will serve: Residence•[°Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: _1__ Number of bedrooms___ Number of baths -A-- Lot size ___x;17-_- - ----------------------- Water ------_--- -----•Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. x Character of soil to a depth of 3 feet: Sand ❑ Gravel [❑ Sandy Loam ❑ Clay Loam ❑ Clay E❑ Adobe&'`Hardpan ❑ Previous Application Made: Yes ❑ No P�j New Construction: Yes R��— o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we _ 'Distance from foundation-Jr__r______.Material _I •_(I- _- -1`--. No. of compartments .__Size___ .__ Jpth CapacitY ' �` Dis osal Field: Distance from nearest well-/^Distance from foundation--/ j tr r p �_ _�__'Li w`d de p s� / Distance to nearest lot line---- Number of lines--------�----------------------Length of each line----- --------------Width of-trench------8��--------------•-- Type of filter mate ria e//—.__ Depth of filter materiaL_...�c __------ otal length------ - --------------•- •-- Seepage Pit: Dlistance'to nearest well_-'__ Distance from foundation__ Q-.�..___ Distance to nearest lot line.�_f__ Number of pits.___.l__.._-_.___Lining material-(��-�i!tyt�ize: Diameter_.__-___.- Depth------ Cesspool: Distance from nearest well_________________Distance from foundation.:.__._.__:_ _.Lining material__._____-_--_____._.____.____________- ❑ Depth---------------------------------------------------Liquid Capacify------------------------•--gals. 4� i Size: Diameter----------------------------- - Privy: Distance'from nearest well------_-------------------_----------------------Distance from nearest building-------------._.____---------------------. ❑ Distance to nearest lot line---- ----------------------•- -------------------------------------------------------------------------------- - Remodelin and/or repairing describe :.____...___ , _ -------------------------------------- -----------------------L-------------------- ----------------------------------•----------------------------•--•---•----------------•------•------------------------------•-•--------•-------------------•--------------------------------------------- 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. (Signed).. .... ----- J �- E ----------------=------------ -----{Owner and/or Contractor) By:.. --- ------- - Title = ( 1 -� -- - --- (Plot plan, showing size of lot, �aio`nof system in relation to wells, buildings, etc., can be placed on revers side). FOR DEPARTMENT USE ONLY _. APPLICATION ACCEPTED BY--- --- - --------------------------------------- ----- --------- - ----- ----------------- - DATE---;~---•--•--------- -------------------.... --------- REVIEWED BY---------------------------- -- --- ----- --------- ------- ------ ----- DATE__A"----------------------------- BUILDING PERMIT ISSUED------------------------ ------•_---------------------------------------------------------------- DATE.... Alterations and/or recommendations:-------------------------- -- ---- - ------ -----------------------------------------------------•-•-U-------------•-----------------------------•--._._._ ----------------------------------------------------------- - --------- - __---. � --------------------------------- ---------------------------•------------------------ ---.----------------- . FINAL INSPECTION BY:--------- - - -- --- ----5--------- ------------- Date--- .6 `5 ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-3 145446 ATWOOO