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APPLICATION FOR SANITATION PERMIT Per it No. --- Z -- (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 LOCATION_ _ r• __ -----•---•-•---•------ -------------=-- -- -----Owner s Name ------------•-------••------- --•----- PhAddress --- one --------------------- ..... ----• ------ - ----- --- ...... Contractor's Name------------------- - . ---- --------------------------------------------- --- -- -------- --- -= - �(�-- - ----------- Phone - -- Installation will serve: Residence - � partment douse ❑ Commercial ❑ Trailer Court 1 • ` ❑ Mote Q Other ❑ Number of living units: _l-___" Number of.bedrooms '-_�. Number of baths .__�___ Lot size ______-74 4--.-"-".-_-- Wafer SuPPI . Publicsystem 9__Co-m munity system ❑ Private'❑ ..Depth to Water Table -------- f}. Character of soil to a depth of 3 feet: Sand ._-Gravel ❑ Sandy Loam-❑ Cia Loam Previous Application Made: Yes o El New Construction: Yes�o ❑ y El Clay ❑ Adobe [3]--�f-laFdpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} - Septic Tan Distance from nearest wel)------------_....Distance from foundation-__._-____.___._._Material-______-_-..___..--"-_-"-__-_- No. of compartments.__-- __ --- ----"• /r. -- ------ -----Size-------------------------------- Liquid depth--------------------------Capacity-•--------------------• Disposal Fie d: Distance from nearest well------------------Distance from foundation___________________Distance to nearest lot line.___.___.- ❑�r Number of lines-----------------------------------Length of each line---------- Type of filter material--------------- Width of trench.-------------- ' - " _Depth of filter material___".-._.----_-----_ Total length-___.__•-----""-.---__""" --_-----"--- _ " Seepage Pit: Distance to nearest well-."-..._(""`-- - istan from f undation_____ 4 * pp �_.______.D' tante to nearest lot line" - -� . Number of pits_____ __________""-__Lining material____ r,M i Size: Diameter- -----------Depth--- --------- G1 Cesspool: Distance from nearest well_________________Distance from foundation......-.......__._-.Lining,material _"_:"----_"_ ❑ Size:' DiarhefeDepth = --- --------t ---------- --------Liuid Capacity- -----:-------------------gals.Privy: Dis=taace from nearest well-------________.. ---=-------------_""---------Distance from nearest buiidin ❑ Distance to nearest lot line---- - 9 ------------------ -------- -- ---- ----------••----•--- Remodeling and/or .. - r repairing (desc_ri.bte):---,-_., -'"-�--fie:* ---p C-•--- --/ ---- `a ---- ------. em „ 0r -----------_-----------------•-----------•--------•-------------------•----- .--- --.---- �C -------------------------------------------- = •------••-----------•-------- ---------:------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulesd re ations of the San Joaquin Local Health District.. (Signed)--..- -- -- ---------- Elyq s - ---- e l ner n /or Contractor) 'tie)---------- (Plot plan, showing siz of lot, Iota on of sys em in relation to wells, buildings, etc., can be placed on reverse side FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------y ---_--- - DATE_ -r------"• aREV --------------- IEWED BY = DATE-BUILDING PERMIT ISSUED----- ----------"-- ---------- -----•._ -----------------------•----------------------------=--------. DATE-------- -------------------------------------------------- --------------- Alterations and/or recommends+ions:_--------------__________ __ ---"""--- �- ----------------------•------------------- - r -- --- --------------- - - -- ----- ----- -. ---- ------------- ---------------------------------- ----------- --------------------------•-------- •- ------ - FINAL INSPECTION BY:--------- �Zx�_ -----------•-----------•---- Date-- ' ._ r SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street Stockton, California8!4 North "C" Street Lodi, California Manteca, California Tracy, California ES-9 145446,nrw000