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_A4 AK APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Data Issued iApplica4-ion-is-hereby'made toLthe-San`J6ii_juinLocal-Health District for a permit to constructed install the work herein described. This application is made in compliance with County Ordinance No. 549.. JOB ADDRESS AND OCATION 01 Owner's Name-, 2, --- - - ------F 0 , ------- Phone----- ------------------------------ Address---------- 1_ Contractor's Name ......q----- ----------------------------------------------- ----- Phone._---------------------- Installa.tion will serve: .Residence jg_ Apartment House ❑ Commercial [-] Trailer Court F] Motel E] Other El Number of living units:/---- Number of bedrooms --2—,-Number of baths Lot size `-__. ---- M -X_----- Water Supply: Public:system GL-Community system [-] Private [] Depth to Water Table /4-40ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam E] Clay E] Adobe [X, Hardpan ❑ Previous Application Made: Yes E] No � New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we -Distance from foundation--- g9------_....Material..-C-C-A_Cf1_4_& No. of compartments..-..- __ i;;- ---------- clep�h__..56�_ ------------Capacity---74zr�_ -------- Disposal Field: Distance from nearest well__/.1/4&N<1i.5tance from founclafion___�.'-----Distance to nearest lot line-- Number of lines-------- Length of each line--- ---Width of trench..-.2-9- --// /_ --- -------- /-------------- Type of filter material----IhC-- ��Cl)epth of filter material.-___r. ._____---Total length..--- ,,0__4Pr-----_----------------- Seepage Pit: Distance to nearest well__ Distance fro m foundation--_..(_.d-.--.-.Distance � nearest lot line--Ae------ W_ Number of pits------/---L:-----------Lining material: Diameter----- $-------Depth__.__t5�� Cesspool: Distance from nearest well-----------------Distance from foundation................._.Lining material-....-_------..-_-___---------------- F-1 Size: Diameter---------------------------- - ------Depth------ ------- ------------------_---------------Liquid Capacity---------------------------gals. Privy: Distance fro-in),nearest well-------------------_-_-_---_--- ---_---Distance from nearest building....__-..-.-.---.-------. ❑ uilding-------------------------El Distance to nearest lot line.----- -------------------------------- ---------------------------------------------------------------------------------- ------------ Rem6&ling and/of 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, St:&! �as, and rules and regulations of the San Joaquin Local Health District. --- ---- - ---- ----------- ------------ -- --------------------------------------------------------------------_(Owner and/or Contractor) V By:. .... . ..• . - ----------------(Title)----- (Plot plan, showing size of lot, location of system in relation to wells,•buildings, etc., can be placed an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------ ------ --- ------- ----------------=-------------- -•---- DATE. -- ................. REVIEWED BY ------ --------------- DATE-- BUILDING PERMIT ISSUED--------------------------••--- --------------- DATE-------------- Alterations ------------------------------- ---------------- - ----------- ---------- Alterations and/or recommendations:-___----............ ---------------------------------- ... ---- -- --------- - -- ------ ----------------- -- ------------- ----------------------------------------------------- --- -----------I.......-------------- --------------- ... .... -------------- -- --- - -- -- -- ---- - --- - 77 I-P-- -- ------- ------- ------ ----------------- --------------- ---- ------- ----- --------- 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 145446 ATWCOD