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l - i J Y s APPLICATION FOR SANITATION PERMIT Permit No. y (Complete in Duplicate) Vr t Date Issued 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-----------P_4r wil Owner's Name------------------------o'+r _ 3''! J"T6- -------------------------------------------------------------------------------- Phone------------------------------------- Address------------------- ------ -------------•--------------Address-------------------;52.0 FI - j ;52-FA s a.= - ------------------------------------------------------------ --------- Contractor's Name -------�'^'"_'- -- --------------------------------------------- ------------------ Phone - Installation will serve: Residence kj Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: -------- Number of bedrooms --_>--- Number of baths ----j--- Lot size _-___-_ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table _4s, ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ #Clay Loam ❑ Clay ❑ AdobeX Hardpan ❑ Previous Application Made: Yes 0 No ❑ New Construction. YesX No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r � Septic Tank: Distance from nearest well----_Ip______Distance from foundation_-___-1d______ _Material________ _ __ __________'______----_-____. No. of-comFiprtments-----------------------Size----�- - - ------Liquid depth---------5A'A--------Capacity---- Disposal Field: Distance from nearest wail_-.-10�_-_Distance from foundation-------ID_4------Distance to nearest lot line-----r-_--__ Number of lines______________ f Length of each line----- 0-"-X_ Q.'-_Width of trench_:_----_ -//-___--______•_ 0 Type of filter material___--_ _ ------------Depth of filter material___--__[_9/_------__Total length---------]-? -/------------------ 4( Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- 171 Number of pits----------------------Lining material-----------------------Size: Diameter------------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material__-_-________________-_______.____._ a ❑ Size: Diameter-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well______-------------------------------------------Distance from nearest building------.-_____-_-_-__--________-__._._..._. ' ❑ Distance to nearest lot line A�j) � Remodeling and/or repairing (describe):------------------------------getu----------- ---- --------- -•------•-----••---•-------•-----•-----------•--------- --------------------------------------•-•----•-•-------------------•---------_.....--------------------- -----------------------------------------------------------•---------------------------------------------•-------- ----------------------------------------------------•-----...-------------•-----------•-••-.------------.-•-------------------------------------•----------------------------- --------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed) 44, -- -----------------------------------------------------------------(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------____-- -- R£VI£WED BY ---------------------------- -------- 0------ ---I--- DATE------------ ---- BUILDING PERMIT ISSUED-------•---- - --- - - ------- - -- ------------------------"--------------------- DATE Alterations and/or recommendations------- ---------------------- --------------------------------------------------------- -1---------------------- ---------- --------------------------------------------•----------------------- - -------------- ---- ---- -------•----------- iv ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-----:�/ ' = Date ? 0 � r� ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street I32 Sycamore Street 814 north "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M 8-SI Revised W-2100