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Zr APPLICATION FOR SANITATION PERMIT Permit No. _-...--I [Complete in Duplicate] _ Qate Issued -- 3'l� Applica+ion is hereby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein describ This application is made in compliance with County Ordinance No. 549, /"�'� JOB ADDRESS AND LOCA ION-- -0--1 A' —-------------_7 Owner's Name--------------------- Address -------- ---- -------• - - Phone.------------------------ - -----•- - / ...-- -- - "----- ---- _t----!..-------- ontractor' s Name-----------.:.. .... P: ---- --------- ----------- --------------- -- --- �-------- ---------- -------- --- ---•- ------ Phone------•-•------------------------- Installation will serve: Residence [�/artment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms ----?_ Number of baths.---/_ Lot size '_"--- ater Supply: Public system ❑ Community system-E] Private E+`16epth to Water Table_?__-_'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand 'Loam Y lay Loam [] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ No �ew Construction: Yes E-IN_o ❑ TYPE-OF-INSTALLATION AND SPECIFICATIONS: _ No se #i t nk�or,Cesspool pe—rm��}ted if p bli�'_sewe is availa le wifhin 2Wfee I)'„�=' Septic Tank: Distance from nearest well451from foundation_ D--- ._ ----..M a t eri a L.t t �- - C --Capacity----'- --� No. of corn armens'... p - - -------- -.Size/�X--c�-- x--�-----Liquid depth---- 3------------ Disposal Field: Distance from nearest well__�--5--.--- -Distance from foundation --- nearest lot lige.--�._.---_.___ Number of lines-- :-Q' -- Length of each line-------.�. _-------------Width of trench__ Type of filter materiai_ r_ _-__G Depth of filter material---_-� -��- - �j y Total length' ---`�-- --- ---- ---- Se I epage Pit. Distance to nearest well-__-_---------------Distance from foundation Distance to nearest lot line--___.�..r,_. � * ❑ 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 from nearest well ---------------------- --------------._Distance from nearest building Distance to nearest lot line_________________________ Remodeling and/or repairing (describe):__-_-- -------------•------------------------- 1w, i ---•------- -------------------------------------------------- -------------------- ------------------ ------------ ------------ --•----------I--------------•----------------------------•----------------------------------------------------------------------•---•----------------------------------- 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 JoaquinLocalHealth District. - e. - . :.� = to w 1BY�' -.. - - -._ --------------- -------- -----------------------------(Title) =------ (Plot plan,` owing size of lot, Iotation of system in relation to wells, buildings, etc., can be placed on reverse side-- Y ------ _ + F DENJ,�USE O Y APPLICATION ACCEPTED BY------- ----.e-- ---- -- --- ----- --- DATE---- -_ P-. _., REVIEWED BY ----------------- ---------------------------------------------------------------------- --------------------•---------------------- DATE------------------------------------------------------------ --------------------------------------------------------------------------------------- PERMIT ISSUED___ _____ --------- ---- ------------------ ------- -- - ----- -- DATE---------- -----------Alterations and/or recommendations------- -------------------------- -----•---------------------------- ----- -- -- -- -------------------- FINAL INSPECTION BY:------.__ -_ - �- � -. . ------ -•------------------- Date--.------- -- -.�„--�"" �.- --- -- -- - ---------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street', 132 Sycamore Street 814 North "C" S+teat Stockton, California Lodi, California Manteca, California 7recy, California ES-9-2M 145446 ATWOOO