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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) PDate lssuedff� �"'r- Appliba4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor descrlibed, j This application is made in compliance with County Ordinance No. 549. /� --- JOB ADDRESS AND LOCcATION `---------- - . -------------------- ----------------------------------- 7__----- Owner s Name--------- --------- -- t,� ---•------------------_ #.. Phone d ------------------ ---------+ -------------_-------- ----- Address_.... �i ?� Z ?7 ----- "-------------- --------------------------- ------------------- ------- E.� Ea ia-------------- --Contractors Name----- --------- --------- ---- ---------------- ----- ----•------- ------------------- Installation will serve: Residence ®/Apartment House E] Commercial [I Trailer Court ❑ Motel F] Other ❑ }Number of living units: _/--- Number of bedrooms 3-- Number of baths __/___.Lot size °--- ---- ------------------------ --• Water Supply: Public'system L1 Community system El Private �pth'to Water Tabls,__ s #. Character of soil to a depth of 3 feet:Sand ❑ Gravel El Sandy Loam E] Clay Loam ❑� Clay E] Adobe Hardpan E] Previous Application Made: Yes ❑ No ® New Construction: Yes ,9R-'flo ❑ F TYPE OF INSTALLATION AND SPECIFICATIONS: 1 st F � ; .[No septic tank`or cesspool permitted it public sewer is available within 200 feet.) P Y.le- .t. .-;.:f.... Septic Ta k: Distance from nearess well-- Q_ Distance from fcurcl� ion- ---�-.---___Material__. ---------- a�--- -Size-S __1C4V�------ ---Liquid 'de th_---------- -- ----------- Ca aci No. of compartments q p. i p tY--�1� t i Disposal E'eld: Distance from nearest well-SQ--------Distance from foundation_-_ ` --.......Distance to nearest lot line---4-------_. ----------------------Len th of each line_-40'.'Ga G o -Width of trench--- y_••----------•---_"---- Number of lines--_ - 9 , Type of filter material-"S�-��0-___Depth-of Vfer material-_"l __--"-�otal length-" - ----------------i-------•• -— . - .i n- , ...... - -, Seepage Pit-, Distance to nearest well----------------------Distance,from foundation---.__ -----------Distance to nearest lotine------ --------- I�, F - Lining material-----------------------Size: Diameter-----------------.------.Dep - th-----------------------_------umber of pits.-_--..--__--,-_"_ - I Cesspool: Distance from nearest well----------------Distance from foundation--------- ---------Lining material--.----------------------------------------------- Size: Diameter-ks ------- ---------------------------Depth-- ------------- ------------- '-------- Priv Liquid Capacity gals. Distance from nearest well--- ------ .from nearest building._ -.--_.----.-____-_-----_------------ I Distance ' Distance to newest lot line ------- =--------------f 4 ' i -- j Remodeling and/or repairing (describe)------------------------------------------------------------------- t f ----------------------- ----•---• I ---------------------------------- ------------ ------------;------------------------------------------------------------ I i -----------------`--------------------;-----------------•-------------------------- i ' - - -- ---- ------------- ----------------------------------------------------------------------------------------------------=------=-----------•----------------------- -------------------- ordinances, State laws, ` I herebycertifythat I have prepared this application and that the work will be done in accordance with'San Joaquin County !and rules and regulations of the San Joaquin Local Health District. t - ---- --------- -low,nef and/or Contractor) [Signed)--- --------------------------------------- By:-------•--------- [Title) " (Plot plan, showing size of lot, location of system ph relation to wells, buildings, etc., can beplaced on reverse side). I..� FOR DEPARTMENT USE ONLY {-� --------'----• APPLICATION ACCEPTED BY-------------------------------------------------V-- --------------------------------- DATEt1 REVIEWED BY -------- DATE------------------------ ------------------------------------ ------------------ DATE.------------------------ --- BUILDING PERMIT ISSUED------------------------- - - ------ -------=-------- Alterations and/or recommendations:--------------------------------- ---"•--------------"------------------..:-----------.--------------------------------- ? -- --------------- -------------.. " --------------•------------------•--•--------------------.---------------••----------------------- ---------- -------------------•-- Yr -------------------------------------------------------------------------------------------- --_--•---.-•---------------------------------------------------------------"--------------__--------------- i I --"-- - , ----. . { ---jj-•-�------- -------------------------- .4 ..-------`.-----------' � D •: --------------------- - FINAL. INSPECTION BY.. --�--=- - ------ -------- --__ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California j -Lodi, California Manteca, California Tracy, California '% y SES--4-2M - Remised W-2100