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yra 1 Ad; . , CATION FOR SANITATION PERMIT Permit No.s.-. .•_ - (Complete in Duplicate) �- Date Issued } Applica4-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. JOBADDRESS AND LOCATION------------ -1._5�57----- ---- �----t- -------------------------------•---•-•--------------------------------------------•---- Owner's Name *------ -gyp Phone -7�= __ ------_- -t. - 7 y . . , ,. ----------------------------- ------------- Contractor s Name------------------------------------- - - - •- - -------•----------------- --------- ----------• ----------------- -------------•-- Phone----------------------..:---------- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court [:1 Motel ❑ Other [INumber of living units: -------- Number of bedrooms . Number of baths .k----. Lot size ----------------____________________________________________ Water Supply: Public system Community system [IPrivate [:] Depth to Water Table ________ ft_ Character of soil to a depth o{3 feet: Sand ElGravel ElSandy Loam ElClay Loam ❑ Clay Adobe E] Hardpan F] Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) L) Septic Tank: Distance from nearest well--,-_-----_____Distance from foundation--------------------Material _________________--- _________________-____- ❑ No. of compartments-------------- ----------Size.-------------------------------Liquid depth------r-------------------Capacity----------------------- Disposal Field: Distance from nearest well_--------------__Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines----------------------- ----------Length of each line-------•---------------------Width of trench---------- ------------------------� Type of filter material---------------------:--Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line_______________-. ❑ Number of pits---------------------Lining/material--------------- -------Size: Diameter----------------------Depth- - --------------- ----- % yyp Distance from nearest well__------ Distance from foundation- -______.Lining material--. ----�__-_-_-. Size: Diameter._. -----------Depth-----fd- ---------------Liquid Capacity----------------------------gals. Distance from nearest well---------------------------------------------- --Distance from nearest building------.----------------------------------- 1 ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------- ----------------------- Remodelingand/or repairing (describe):---------------------------------------------------------------------------------------------------------------=----------------------------------------- --------------------------*-------------------------------------------------------------------------------------------- " -•---•-----•-------------•----------------------------------------------------------------------------------------------------------------------------------------------- --- ----- •- - -•------ ------------------------------------------------------------- ------------••-•-----------------••-------•-••-----------------------•----------------•--•------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County l ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. i (Ss ned) Q �-- --------------------- ------------------------------------------(Owner and/or Contractor) -------••- 8y:------------- --------------------•-•------------------------------- ------------------ _ {Title)----• -------------------------- ----------- ------- ---- (Plot - 1 plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY .� DATE---------_-•---•--- -- -- --- - APPLICATION ACCEPTED BY_ --___---- ------_---- " # - ---- - --------- REVIEWED BY-------- DATE .._ •---------- DATE------------- BUILDING PERMIT ISSUED - I r • =-------------- - - n I Alterations and/or recomment(a�ions--------- ---- -- •— f --•�- ------- ------------------------ 04__% ---- ---""-- �' _ .._4 ?------ : _ :te a e�-- :., _.,� ` " ` ` ' � ' I f I . •------------- -----------•--- --------- - '' _ r- -----•----------------------------j_----- ` .411 ,. . ----------- ---------------- ---- - - . :. FINALINSPECTION BY-------- -----------•---- --------------------•---------------- Date--- -------------------- ------• ------------------------•------------••-•-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 1 E5-9-2M 145446 AT WOLIn 12-54