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-� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) 7. Date Issued Applica+ion is hereby made to th'e 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 N 549. JOB ADDRESS AND CIQATI Owner's Name -; - ------------------------------------- '; .. Phone.. { Address = ----- --------------- ------•-•-•--•---------•--•--•-------- I ------------------------ f . Contractor's Name--•... ................... --------------------------------------------- Phone...................-.............. Installation will,serve: Residence Apartment House ❑ Commercia ❑ Trailer Court 0_-Motel ❑(Other'❑ Number of living units: __ -- Number of bedrooms,.. Number of baths ../._ Lot size ...��.,/��` .......................... Water Supply: Public system Community system ❑ Private [] Depth to Water Table_Z6;`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel`❑' 'Sandy,Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ W Previous Application 4Made. Yes,[] No f New Construction: Yes No ❑ 1 Y TYPE OF#INSTALLATION AND ,SPECIFICATIONS: I 4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k -+ '7:. i r a Septic Tank:, r Distance from nearest wel� '_Distance from �ouundation/W1_-...._.---M00er'al.. ---------------- No. of compartments..�-----------------Size. 1-,, , f ___Liquid depth. ..-.......Capacity.. dQ..._...._ Disposal Field: Distance from nese t wel ...... . ...:-Distance fromfoundation_. r......Distance to nearest lot line_...... Number of lines.._;_-. Length of each line_._-. --V .......Width of trench------- _ _1--�-----.._ t`3 Type of filter"materi _. -----------Depth o r m rial---.. �-------Total length.__ w ¢ Seepage Pit: Distance to nearest wefl .. . �� _�..-.Distance to nearest lot line...__-.- : Distance o ation... ` i< Number of pits- -.--.--/.....-----Lining material —Size- Diameter_ ��.....-_Depfh--.. .----------.. r Cesspool: `� Distance from nearest well.............._Distance froms-oun n �________:_._._-, Lining material......__....__------------------- ❑'. tz -Size: Diameter-- _ z`-Depth------------- -------------------------------------Liquid Capacity--------------------------.-gals. Privy: Distance from re rest well----_------_..................................Distance from nearest building........._.___.._...._ ❑ Distance to nearest lot line__,.............. - - ' Remodeling and/or repairing (describe ------------- . .. .. - � ` -- - ---------- --- .. -- ---------------- �C - G ` ~ ------ � -..- - - --- ----- - ----------------------------------------------•--------- . -------..------------- ---------- •-----------------...---------•--•---------------•------------------------------------------------- --------- I hereby certify+hat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rulavand regulations of the San Joaquin Local .Health District. (Signed)...... ........ ...•- - ------ -.1---( nd/or Contractor _•....•-- 'D ---..[Title ---------- -••---• --—---------------------- (Plot plan, showing size af9o+, location of system in relation to wells, buildings, etc., can be p aced on rever side). ' PI` FOR DEPARTMENT USE ONLY . APLICATIrON.ACCEPTED BY--------- -------------------------------- --------------- � ----------- DATE------ - -------------------------------------- BUILDING _ -- '----------- REVIEWED BY----------------------------------- �--------------------------------------------- DATE------ ---- •_-_-- - --- -�---------- BUILDING PERMIT ISSUED---------------- ---- ------------------------------------------------- DATE-------------------------••------------- Alterations andfor recommendations:--------------------- ----------------------- - ----------------------= __j M ......................................................................_...._..._....._._._-.---...__.._........_....._._._......._..........................._-----------....._.•_------_..._.._._11.11-.............I--..._ ---------------------------------------------------------------- ---- ------ --------------`---•- -------------------------------------------------------------------- •--------------------------------•------ y ...................•--------------•-------------------•---•------------------------------------------------ ------------------ •--------- ------- ----------•------------------------------...------- i ------------ -------------------------------- -----—------------ –_. ------ ---- ------------ ---------- ,. ------------------------------------------------ -------- Date INSPECTION BY:.. r ----------------------------- ------- ---------------- ----------•-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streat 300 West Oak Street 1,32 Sycamore Street 814 North "C" Street Stockton, California s --. .:Lodi, California Manteca, California Tracy, California ES-9-2M 1AS446 AT Wf]tl� i2-5q .�