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L7 APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued V _l ._G ascribed. A s This is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein 's a'pplicbtion is made in compliance with County Ordinance No. 549 JOB ADDRESS AND L - - T 10 N --------- bwner's Name------ - - ------ - r--------------- --------------------------- ---------------- Phone- -------------••--- • 1 , Address ------------------ Address--------------- -- --- ---------- -- ---------------- --------- -------------------------------------------------------------------------- Contractor's Name--------------- -- -- !�---------------------------------------------------------------- P h o n e ,AparZ7 House E] Commercial E] Trailer Court 0 • Motel E] Other Ej Installation will serve. eside''/umber --- Number,of baths ---4, Lot size ------- Number of living units: of bedrooms ----- ----/--—----------------------- Water Supply: Public systernx Community system [I Private ❑ Depth to Water Table ff. Character of soil to a depth of 3 feet- Sand Gravel E] Sandy Loam E] Clay Loam [I Clay E] Adobe E] Hardpan L] Previous Application Made:* Yes E] !NoJI El New Construction; Yes N - �( 0-1� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'ce'sspool permitted if public sewer is available-within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance'from foundation---------------- ---,.Materia-------/--------------------------------------- No of compartments-------------- ----------Size------------ ------------ ---Liquid depth------------- - ------ ---Capacity---------------------- Distance --Capacity----------------------- D;s osa Field: Distance from nearest well-,---v�-----Distance from fouhdation----/ ;-67-------Dist,nce to nearest lot line-----A�F7..... or lines n --------Width of trench----- ....... Number 1 ....... -------4-----Length of each li*�e -------------- f filter material,--n't5t----K-----Depth of filter material- - -_-._Total length-------- -—------------------------- Type or Seepage Pit: Distance to,nearest well----------------------Distance from foundation---------------------k Distance jo nearest lot line____-_--------_-_ ❑ ine----------------- ElNumber of:pits------------•---------Lining material-----------------------Size: Diameter--------:----.---------Depth------------------------- ------- Cesspool: Distance from nearest well-----------------Distance from foundation____------_.------- Lining material----___---.-___._._..-.--.-..-..-.-_ -- 0 Size: ------------- --------------_Licl -CapacifY ---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--- ------- --------------------------- F1 Distance to nearest lot line------ ------------------ ------------------- - ----- ----- ----------------------------------------------------------------------- - - ------------ ------------------------ Remodeling and/or repairing (describe):-_ ---------- - ------------ --- ----------------------------------------------------- -------------------- ------------------------------ -------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- ---- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law A—, a id rule n regulations qf-FFm San Joaquin Local Health District. (Signed)--- ---------I----------------------------------------------------------(Owner and/or Contractor) -- ------ -- ------- ---------- -------- o B --------------------------------------(Tif le — -- ----- -- y:------------- ------- ------------------------------ -40 e). (Plot plan, showing sizeof ocaflon of.system in relation to wells, buildings, etc., can be 1�e6on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE --------------------------------------------------- REVIEWEDBY - ------------------------------------- DATE- ---q5\------------------------------------------7------ BUILDINGPERMIT ISSUED-------------- ------------------------------- ------------------------------------------- DATE---------U----------------------------------------------- Alterationsand/or recommendations:--- ----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ ------------------------------- --------------------•-------'--'------"----------------------------------------- ----------------"--------------------------------------- ----- ----------------------------------------------------------------------------------------- --------------------------------------------------------------------- -------------------------------- --------------3----------------------------- -----------------------------------------------------------------------------------------------------—----- - --------------- ,I . ----------------------------------------------------- -------------- ---- ---- -------------- -------•----------------------------------- ----------------------- ----------------------------------------------- FINAL INSPECTION BY,:-. ----------:1----------------- Date.... ...... ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California is V9-2M 10-52 Revised.,W-2100