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b y APPLICATION FOR SANITATION PERMIT Permit u (Complete in Duplicate) Date Issued Y- -.q �-_-cs A lica on is hereby mad pP y e 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 JOB ADDRESS AND LOCATION----- -'V- ------------ + --------------------------------------------•------------------------------- Owner':; Name-------------- --- - -------------- -- ------------- -- Phone---�-7-2--�- --------- Address---------------------------e,'2f Contractor's Name--.--- _---_ -------- ----------------- - -------------------------------------- Phone - --------------- Ins tallafion will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ® Motel ❑ Other ❑ Number of living units. -,/--- Number of bedrooms -,/---- Number of baths _'� Lot size -AQ__Z__Y/�f Water Supply: Public system DI Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ 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.) -� Septic Tank: Distance from nearest well (l_--__Distance ,from foundation_./-D- ------Mat jial/u c� - .............CA No. of compartments-------, --------------Size--; ,�(--, -�(_ Liquid depth-__= ,e^-----------Capacity-- --- ; Disposal ReA'.' Distance from nearest well- !'�-s"4Distance from foundation--------------------Distance to nearest lot line--±3_ -_ Number of lines------------------------i.........Length of each line---------- -- ---_-_-Width of trench-------------"----____-- Type of filter material---------- ------------Depth of fitter material--------.---_----------Total length--------------_-----,_- , ------------ -- - Seepage Pit: Distance to Nearest well-oxr4`n� Distance from foundation-1A__-------.-.Distance to nearest lot line-\J-.—, Pr Number of pits-----j------- -_-Lining material-----------------------Size: Diameter----., ---------------Depth-___.Z_j`-------------- ---- Cesspool: Distance from nearest well------ -----_Distance from foundation--------------------Lining material---------------__________�-------- ❑ Size: Diameter--------------------------------------Depth-------------------------------------- ------------Liquid Capacity-------------------------- . Privy: Distance from nearest well------------------------------------------------- from nearest building---_-____ --- ❑ Distance to nearest lotline------------------------------ ---------------------------------------------------------------------------------------------------------------- 5?_ Remodeling and/or repairing (describe)------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------- --------- --------------•---------------------- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan , tate laws, and rules and'regul tro of the San Joaquin Local Health District. � Si ned - ` ---_- =- -- ---------------------------{Owner and/or Contractor) By:------------------------------- -------------------------------------------------------------------------------------------------(Title)--------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ - --------.--------------------------------------- DATE------------------- REVIEWED BY------------------------------------ `� DATE-- - r BUELDING PERMIT ISSUED---------- ------------------------ - -- "` ._� ------------------------------------------------------------- -------------------- --- ----------- DATE- ---------------------------------- -Alterations and/or recommendations:------------- ---------------- ------------------------------------------------------- ----------------------- -------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY _____________ Date--__--1� —�a'�'� __---------------------- SAN .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 ES-4-2M 8.51 Revised W-2100