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! APPLICATION FOR SANITATION PERMIT Permit No. _ (Complete in Duplicate) I Date Issued -_. _____.__ .... Applicatio is ereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 544, JOB ADDRESS AND*LOCATION!1---? 4-----(�8L!n" t]S__. l- e ^" "' ------------------------------------------- Owner's - ---------- -----------------------Owner's Name. - �'--------- ---}--1 .� LA ------ Phone ' Address-------------------------------•--------`' -_ ---•-----------------------•------------------••------------------------ ---------•-------•--------------,----•------- Contractor's Name----------•----------------------•-- 6v=---------------- - ------- - ------------------------------------- --------------- Phone----------- - - ---- Installation will serve: Residence El Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other [ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size -_____._ _ x--_ _ _ - ---------------------- Water Supply: Public system Community system ❑ Private [I Depth to Water Table---____ Character of soil to a depth of 3 fee+: Sand N. Gravel E] Sandy Loam❑ Clay Loam Clay ❑ Adobe ardpan ❑ Previous Application Made: Yes ❑ No ❑ New Construction. Yes4 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publi sewer is available within 200 fee+.) 1 . p S' dation- C ---�� L/ Mat pial --------'- -- ------------------ F � Septic dot of compartments-.- ell istance from Liquid depth________ ------- ------Capacity_ .- ------- _ Disposal Field: Distance from nearest we i 2-i.� , istance f oTto�kVTti n------ -, istance to nearest lot line__-��--- , Number of lines...........� " _____-_Length of each line___-- --_-_�___ moi_ Width of french........ ------------- �. Type of filter material��_ 1 -;-Depth of filter material___. r t------Total length------------ __4?"�___ 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---__--________------__._--_ . .'� ❑„ Size Diameter-------------- ---------------- Depth------------n' ------------ „ _ ...._�"�Liquid�CapacitY -- - gals. y• Distance from nearest we I_._ -_ Distance from nearest building �] Distance to nearest lot line----- -------------------------------------------------------- Remodeling and o' rarn (�doscri eJa � --a ., y_ ___--- -------- --.... ------�------_• - - ma ---------------------------------------------------- ` P ---------------------------------------------- -----------------------•------------------------------------ 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)_ f` ------ -------- (Owner and/or Contractor) By-------------------------- Title ---- -------------------- ------------------------------------ - - ------- - - - - ot 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_______________ -_-_ __I-------------------------------------------------------- vDATE=---- -- ------ REVIEWEDBY--------------------------------------------- ----- ----- DATE----------------- -------------------------------------------------------- BUILDING PERMIT ISSUED ------ DATE Alterations and/or recommendations:-----------..___ ------•----•--- =. J'- rc _ _______________________________________________________________________________-___-_____-____..._-___.___---._..__._______--_-__ _________________________________________._-..__._______---_________-_-_...---_-....______--..._----_-_______,__.__.___._. FINAL INSPECTION `BY::_. . .----- - - Date--.- --'f j - ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American-Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton,_California Lodi, California Manteca, California Tracy, California E5-9-2M'10-52 Revi4,W-2100 ,,� .