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6f0� - F" APPLICATION FOR SANITATION PERMIT Permit No- ----------------------- (Complete in 6uplicate) Date Issued --- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thiisapplication is made in compliance with County Ordinance No. 549. �1.�7-------------- o r_r te) =----------- •----------- JOB ADDRESS AND LOCATION-------------------- �. Owner's Name------------ -•--- ` Phone 1 , : ------��1_Cart----------�t---�-� --=------- -------- � Address -----------------------•-------------------------- ------------------------•---------------------------- 5 m4z4 Contractor's Name _' ------------------- Phone------------------------------------- --- Installation will serve: Residence ,M Apartment House ❑ Commercial �- Trailer Court ❑ Motel El Other El Number of living units-- -------- Number of bedrooms _- -: Number of baths -----✓R_ Lot size ------------------------------ Water Supply: Public-system ❑ Community system ❑' Private j ( Depth to Wafter Table -), ft. v Character of sail to a depth of 3 feet: Sand ❑ Graver❑, Sandy Loam [I Clay Loam [-] Clay [IAdobe T Hardpan El Previous Application Made: Yes ❑' No 0 New Construction: Yes No F] TYPE OF INSTALLATION AND SPECIFICATIONS: I4 (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) t r k D 4__--pistance from foundation----- D-----_--.Material------__ - ePJi-to_v_""d--------------- Septic Tank: Distance from nearest well_-- -- „ No. of compartments-..___. - Li uid de th------ ?-_....--.._.Capacity---.- B�-" " �^-------- Size t ------- q R Disposal Field: Distance from nearest well..___5!/-----Distance from foundation---___- -.._-Distance to nearest I line_ ------. C 4a ;, Number of lines----- ---- --r --1,- - -Length of each line-1 ----�Q---��-�-.-.Width of trench..---------`7�---------------••--- Type of filter material-__-__��tc-------------Depth of filter material--- f-�l`�-------Total length_-_-.-----�. --.- ------•------- Seepage Pit: Distance-to-nearest well'.-._T_"'-'`___--Distance from foundation----------------_-.Distance to nearest lot line--.--_--_. ❑ Number of pits --Lining material-----------------------Size: Diameter------------ ----------Depth---- --------------------------- Y Cesspool: Distance from nearest well------------------Distance from foundation------------------- Lining Cat scat i-, ❑ Size: Diameter----.- ----- ----Depth =. ------------ ---------------- q Capacity ----�g - ' __Distance from nearest building Privy: Distance from nearestwell----------------- ------ -------------------- g ❑ Distance to nearest lot line--------------------------------------------- Remodeling --------------------- - -------------------------- s Remodeling and/or repairing (describe):-------------------------------- --------------------------------------------------------------------------- ----------- e �-- ---•----------I------ ----------------------------------------------- '--------•-' ---------------------------'--------------------------------------------I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Couy r ordinances, State laws, and es and regulatio s of fhe an Joaq 'WLocal Health District. `} 4C --___----Owner and/or Contractor) �. ---- ------- ----------- (Signed) ( ) ------ 1W # I - ------------------------------------- By:-------------------------------------------------------------------- ---------------------------------------------- (Tit e) o - '(Plot plan, showing size}of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --------------------------- DATE -- ------- ----- --- --- DATE-------------------------- ' REVIEWED BY----------------------------------------------I-------------- - -------- --------- -- - BUILDING PERMITISSUED----------------------------• -------------- DATE--------------------I_ ---------------------------------------------------- Alteratians and/or recommendations-------------•-------- -----•------- ------------•-•-----'---••--•---•-- ------------------------------------- ------ -- ----- -------------------•---------------------------------------- ------ ------------------ ! -------------------•-------------------------------------------•--- ----------•-----------•---------- I __ INAL INSPECTION BY:.---- - t �/ � ' -- ---------------- - F Date----- ---- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT Sycamore Street 814 North "C" Street 130 South American Scree} � 300 West Oak Street 132 S y Stockton, California Lodi, California Manteca, California Tracy, California ES-9-2M io-52 Revised W-2100 I