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5 �. APPLICATION FOR SANITATION PERMIT Permit No.�*f ,.--__ ., y (Complete in Duplicate) Date Issued ^--`� i Application 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..--- 4----___ - QL--- Q.�-t.. ` -----------------------------------------------------------------------------------------------•--------------------- Owner's Name- - i- ! 1� �/ - -- ----•-- ------------------------ ----- - ---- ---------- - ------------------ Phone-�---�©_j�-�-- Address---- 4-u—C— Contractor's Name___- -.,A:_ - gr_2�0� - - ---�tllltil�.�r-,�ai-✓�,.-- --------------------- ----------- Phone_.1------ -------------------------------- ------------ ------- Installation will serve: Residence x Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !' Number of living units: __l___ Number of bedrooms . - Number of baths __I-_- Lot size ---- - ` ` -- ------------ E]Community system Private) depth to Water Table ---k ft. Water Supply: Public. system ❑ F Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe% Hardpan ❑ E 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 welt-----------------Distance from foundation--------------------Material-__------------____ No. of compartments-------------------------Size--------------------------------Liquid depth--------------------------Capacity---•------------------- Disposal Field.: Distance from nearest well-__ ----Distance from foundation------/--/, ---_-Distance to nearest lot line--��- ---- Number of lines-------------/---_---- Length of each line-------------------------------Width of french------�-y-�'--------------- � Type of filter material__/� _!-___-Depth of filter material----_ - -__ '__._Total length-----_ �eG�Q --_- f Seepage Pit: Distance to nearest well----------------------Distance from foundation---------------.---Distance to nearest lot line----------------- El Number of pits---------------------Lining material------ ----------------Size: Diameter--------- -------------Depth------------------------- ------ esspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------__--_-------.----__. El Size: Diameter-------------------------------------Depth------------------------------- -------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well---------------------------------------------- --Distance from nearest buildingi ------------------------------------------ ❑ Distance to nearest lot line-------------------------------- Remodeling and/or repairing (d scribe): --------------------------------------- __ ------------------•.----------------•--------------- -------------------------------------- ------------------------------------------•------.._.------------------------ ------------ - - -- -• - --- - ----- hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and' regulations of the San Joaquin Local Health District. _ (Signed)--- �i �- - - . ��s_ R -----------------------(Owner and/or Contractor) --------------- ----------------------------------------------------------------------- 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------------------- REVIEWED DAT --------- DATE ry - -------------------------------------------- IEWED BY DATE_ ----------------------------------------------------- BUILDING PERMIT ISSUED ----•------------------ ------------------------------------------------------------- DATE -------------------•----------- Alterations and/or recommendations------------------------------ -- -------------•---- -----•-------------------------------------------------- /Skit , — / FINAL INSPECTION BY:------- DaFe--- /'z� �jf SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Streef 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California _• Tracy, California ES-9-2M S•SJ Ro0sA'W-2100 '