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/- Jam- APPLICATION FOR SANITATION PERMIT Permit No. - -... -----. (Complete in Duplicate) Date Issued -------y S� 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. , A/ JOB ADDRESS AND LOCATION Ove,-i -- --- --- ' ' - ------------------•- Owner's Name --r ✓moi-i-- ------ _- - Phone. ' - --------•------------------ -•------------•------- - --- Address-------- --_-------•---- - Contractor's Name----04?_ _ � `- " Phone, ` Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1-____ Number of bedrooms __0Z Number of baths __f____ Lot size _- :_ _.., ------------------------ Water Supply: Public system❑ Community system ❑ Private t —' pth to Water Table_, rP_ ft. Character of soil to a_ depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay El Adobe dpan ❑ Previous Application Made: Yes ❑ No [4—New Construction: Yes ❑ No - � a TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) -------- - - Distance from foundation__._---------------Material-_____._____.---______.._________._.---.---____-. Septic Tian Distance from nearest well-_ s iso. of compartments- - --------------------'- Size------•-----------------•-------Liquid depth ---------------------- --Capacity-----------•----------- Disposal Field: Distance from nearest well_ ..�____Distance from foundation__- - -----Distance to nearest lot line.--- Number of lines.... ... ....... .. Length of each line___.__7,�-`_. .........Width of trench- __-�__------.______- rv -r'---'-- r Type of filter material:__f-,L-_._._,k-_..__Depth of filter materia- L.___,le-___.._Total length-------��___---------------------- Seepage Pit: Distance to nearest well_.l _ -------Distance om_fou�dafiion___ Q-- __..Distance to nearest lo�lne_-. r1_e__. -------Lining mate ria Diameter-----------------Depth_-�------- --fi-------• 4 , Number of pi#s_____.�__."- Cesspool: Distance from nearest well________-._.____Distance from foundation___________________ Lining material------------------------------------- Q El Size: Diameter----- ------------ -- ---------- Depth------------------------------------------ --------Liquid Capacity gals. Privy: distance from arest well------------ - -------------------------------Distance from nearest building----------.__..___________-------------. ❑ Distance to;nearest lot line-- -'------'- ---------• ---- ----------------- ----------------------------- Remodeling -'--'•-------'-- -------- Remodeling and/or repairing (describe):---- - -----'-'- ----'---'-'- -'-'----------------•------•------•--•--:-•- •- ------•------ -----------------•---------------------------------- --------------------------------------- -------------•------•------------------------------------------------------------------------------------------ ----------------------- ---------------------------------------------------------- ----------•-------------------- ------------------------------------------------------------------------------------•----------------------- -------------------•--•----•-------------- - ' I hereby certify that:l 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. ontract ) (Signed)-- ------------- ----------------------------- -lot ----------------- -------- frrC or ------------------------------ i, (Title -- ` - -`�-------------------------------- (Plot plan, s owing size of lot, locat�on of system in relation to wells, buildings, etc., can be placed on reverse side). v n FOR DEPARTMENT USE ONLY APPLDATE------------- �'�- "i ON REVIEWED BY__ACCEPTED $Y __- ' ----- DATE------------------------------------- --------------••- -------•---- BUILDING PERMIT ISSUED----------------------------=''----- --- - DATE ' Alterations and/or recommendations:---------------------------------------- ---'- •--•-•----•--------------•-'--------'- -----------•-------------------------------------------------- --- -------------------------------'-----------------"---------------•--------- -----' ' --------------------------- -------------••------• . -------- ----------- ___________________________________________ h- �i//Gi' Date ' ' '^ j- ------ ------------------- ---------•------- 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 Lodi, California Manteca, California Tracy, California f E5-9-2M 145446 ATWCOD 1z-5a -] �.