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APPLICATION FOR SANITATION PERMITS Permit No. ___ _ .... (Complete in Duplicate) Date Issued ._+t -- ------ ' �A� PP lica{ion is hereby rnade,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. I 1J06 AD4RIESS•RND-LO C�NTION-. _ -•• -- -- ----- - - - -- -- - !Ip Phone----c7`- ------- Owner's Name----- J A I --- - -> 0 f -- -_ -- -------------------------------- Phone-_,?.Address------•------ -----• ----- --- s °�� 7 .Contractors Name- ------ ---- � ! .IIS lns#allation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other Number of living uni1.1 ls: _____ . Number of bedrooms -_______ Number�of baths -------- Lot size ,Water Supply: Public syst Community system ❑ Private 0; Depth to Water Table _ - ft_ �ICharacter of soil to a dep �0 Vet: Sand El Gravel ❑ Sandy Loam❑ Clay Loam ❑ Clay E] Adobe [Hardpan ❑ ; IIS I� New Construction: Yes �o E3(previous Applica#ion Made: Yes o F1 ft YPE OF INSTALLATION] AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). Septic Tank: Distance from nearest well----------------.Distance from foundation--------------------Material------------------------------------------------- i No. of'compartments--------------------- ----Size--------------------------------Liquid depth--------------------------Capacity..--------------------- ❑ � ]1: Disposal Field: Distance from nearest well-----------------Distance from foundation____________________Distance to nearest lot line----------------- ❑ Numbelr of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material--------.- -------Depth of filter material----------;------------Total length------------------------------------------ c '::Seepage Pit: Distance to nearest well----------------- ----Distance from foundation-------------------.Distance to nearest lot line______-- ------- ❑ Numbe`r of pits----------------------Lining material---------------------.Size: Diameter________________-----Depth .c_ --- ` ;Cesspool: Distance from nearest well II-__-�__..__Distance_from,foundation----,1_�____.__-.Lining materiaL__ _______________________________-- Size: <7iameter_-__ _Liquid Capacity_...____------------------- els. - Depth �'� g Priv Distance from nearest well------..____------------------------------------Distance from nearest building------.__________---_------------------- _- Y II ❑ Distance to nearest lot line-------------------- --------- --------------------------------------------------------------------------------------- I Re od ing and/or repaiir�ing (describe): � -- - -� `�4`�-- - - °,-" ----------�1-------------------- --------- --------------- •---------------- III. z = ------------------------•------------------------•------------------•----------------------------------------------------------------- -= �-' have prepared this application and that the work will be done in accordance with San Joaquin County I hereby certify the#s� p p Pp ordinances, State laws; aril rules and regulations of the San Joaquin Local Health District. !p (Signed) -- - ---------------- -----------I--'--- ---------------- -----(Owner and/or-Cio-atimmillIor) By--------_---------------- ... -(Title)---------------------------•--------•---------------:.:---------- i (Plot plan, showing size of Eot, location of system in relation to wells, buildings, a#c., can be placed on reverse side)-, u� FOR DEPARTMENT USE ONLY : I Q i APPLICATION ACCEPTED BY- i wt��----------------------------------------- DATE REVIEWED BY----------------`Il' DATE--------•------------------•---- - -- ---------- '; BUILDING PERMIT ISSUED--------------------------------------------------------------------------------- DATE Alterations and/or recoreimendations----------------------------I--------------------------- -----•-------------------------- .I0 -------•---------------------------------------•---------------•-----------•----- -------------------•---- --------------------------------- ----------------- ------- - ----------- -------------------•------------------------•-------------------------------------------------------------------------- ------------------------•-------- -- i -------------- ------------------------------------------ --•-------------------------------------------------- Ile Kl� 4 � —I r —'s-41- i FINAL INSPECTION BY:._ Date------------------------------------ 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 I • E5--9-2M ; Revised W-2100