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FXj APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued Applica+ion is hereby made to the San 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 AND,LOCATI N:#---C ----C-0,J----- ------------------------------------------------------------------------ Owner's Name .. - -_.C7 aB Ix x�`------------------ Phone Address-----------s.9 ----------------------------------------------------- --------------------------------------------- ------- --------------•---•--------------------------------- Contractor's NamC'- - -------------------- - --- -------------- • - --- - ------ Phone-------------------- -------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other/ff-141eq�t1�� Number of living units: __-__--_ Number of bedrooms ________ Number of baths .___I. Lot size -------------------------- Water Supply:Supply: Public system [R�ornmunify,-system E]., Private ❑._,Depth toMWater-jTable v._v'ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 91_�ardpan ❑ Previous Application Made: Yes ❑�.No-❑ New Construction:- Yes:❑i No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f 1 (No septic tank or cesspool permi+ted if public sewer is available within 200 feet.) i n p Septic Tank-: Distance from nearest well-I�Q�CDistance rc, foundation__.1_�_.r____.Material--__5�-- ._FJ /` - -__..___._____- ®./ No. of compartments.-------__./....___....__Size____ ______________ Liquid depth......6 ---------Capacity__-:__a&_<- ?L nearest well__ ___._.._Distance from foundation Number to nearest lot line_________________ Disposal Field: Distance from ❑ Number of lines-------------------------=---------Length,.of,each line---------------------------.-.Width of french-------------------------------- Type of filter material-------------------------Depth of filter material-___.,------.----------Total.�1length------------------------------------------ fi - � Seepage Pit: Distance to nearest well_ /¢.^✓�_Distance fr m foundation______ ___.__----.Distance to nearest lot iine___ -_________ Number of pits-'-----.-- ---------Lining materiaSize: Diameter---• -_--.Depth-----.. - 4................ Cesspool: Distance from nearest well-----------------Distance from foundat+on---------------__-,Lining ❑ � - material_ ______...____.___..:___-__________-__. Size:'Diamefer--:-----�---------------------------De th-------_- ------- ------- --.------ --- ----------- Liquid Capacity------------------ -- ------gals. 4 Privy: Distance from-nearest well________________________________________________Distance from nearest building------------------------------ ---_-. Q ❑ ., .,.,,a. _ - •-------------------- .Distance to nearest o . line-------------- -----------------=- -------------------- ( , til a Remodeling and/or repairing --------,5xf T / ____-- --------------------------------------------- - .-..... -----•----------- ---•--•-----------------------------------------------------------------------•------••-•--------- -------------------------------------------------------------- --------------------------------------------•--------•------•---•--- ------•---•-------------------------------------•-••----------•-•----------•------- -- I hereby certify-tha+ I have prepared this application and jhat the work will be done in accordance with San Joaquin County k ordinances, State la£i , nd rules and reg +ions of an Joaquin Local Health District. (Signed)--- _ ------ - { rand/or Cantrac+or) -----------(Title)------- -------- ----- ------- --------- (Plot plan, showing size of lot, loc ion of system in relation to wells, buildings, etc., can be placed on re rise side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ DATES:----------------------------------------- - REVIEWED BY ------ ------------------- DATE' _... BUILDING PERMIT ISSUED------------ ---------------- -- --- -- DATE------------- - ------ --- - ---------------------------------------------- Alterations and/or recommendations------------------------------------ -- -------------------•------------_-------.---------.------------------------------- --� of -------------- -------•--•-•-•--------------- --------- , _ ' ----- ---------- ---------- r--------- ------------------------------------------------------------------------------------- ---- -- FINAL INSPECTION BY:---- ___._ ��` `� ---- ---------------------- Date-------- - --------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 30D West Oak Street 132 Sycamore Street $14 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, Californst, ES-9 145446 nrwpoo