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APPLICATION K�SANITATION PERMIT Permit No. (Complefd'in Duplicate) Date Issued --- Applica-lion is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance Ordinance 549 P e with County Ordinance CATION lg JOB ADDRESS A�41) b Owner -------------------- ---------------------------- Ph -one ------- -------- s Name-- ------------------------ Address_ -- ................. - -------------------------------------------------------------------------- Contractor's Name ---------------------- ------------------------------_----------- Phone---- !_. ------------ ------------------------------------ Installation will serve: 'Residence Apartment House F] Commercial E] Trailer, Court E] Motel L] Other E] Number of living units: .__f�Number of bedrooms Number of baths Lot size ---- 1 ----O------------------•-_-----_- Water Supply: Public system Community system E] -Private F] Depth to Wafer--Table:��:-ft.0, Character of soil to a depth of 3 feet: �Sand E] Gravel E] Sandy Loam 0 Clay,Loam E] Clay E] AdobM Hardpan E] Previous Application Made: Yes [] Np,!e New Construction: Yes Ej' NoA TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest ----._Distance from founda+io_'f� ._'_'___Mafericil ------------- No. of comparfmen1s_.,'Z-.--------- Size �yd d y----- ---LiqufIdepth ---------CapaCit - W Disposal Field: Distance from nearest well------------------Distance from foundation."--,,---------------Distance to nearest lot line----------------- o Number of lines------------------------------- ----Length of each line------------------------------Width of trench----------------------------------- Type rench----------------------------------- Type of filter material-------------------------Depth of filter material----------------- z.-Total Jength------_------------ --------------------- Seepage Pit: Distance to nearest well----------- -------Distance from foundation--------------------Distance' to nearest lot line----_---___----_ ❑ ine----------------- El Number of pits---------------- ----Lining material----------------------.Size:Diameter------------ -----Depth----------------------------Cesspool: Distance from nearest well----------------'Distance from founclafion--------------------Lining material.._--.--.__-_.----_.--__------_------. El Size: Diameter----------------- ---- ----------------Depth------------------------------ - ---------------------Liquid Capa ity 4 Priv wY: Distance from nearest well .--------------------------- ----------------Distance J " from nearest building--------------------------------------- Distance to nearesf,16t1i�e__,.__ _ - --------------------------------------------------------- ------------- Remodeling a/or repairing (describe);-'`---- <-- - --- -- -------- ✓ -------------------- ------------------------------- --------------------------------------------- -------------- --------------------------- ------------ -------- ------------------ --------- - h, ---------------- ----------------------1�------- -- - ----- --------- --- -- - ---------------------------------I—'-------------1-1------------------------ ------------I---------------------------------------- ------------- ------------------------------------------------------------------------------------------------------------------------------1: -------------------------- I hereby certify that I have prepared this application and }hof-the' rk will be done in accordance with San Joaquin County wo ordinances, State-_laws,:.and'jrlest and regulations of the San Joaquin Local Health District.: (Signed)------ ------- ef ------- ---------- Z ---- ------------------------------------ --------- Wrier and/or Contractor) _C -------------- ---------------- ---------------------------I------- ------ By:---------------- i - — — ------------------------- -------- ...... ---------- ----- (Plot plan, showing size of lot, location of system in relation to wells;'buildings, etc., can be place- on rev�se!tside)� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BA----------------------------------- --------------------------- -------- DATIE-;:---' ;---------------------- - ---------------------------------------------------- REVIEWED BY-------------- 1�_, ---------------- -----------1_"' - -------------------- -------- DATE__ ' -- BUILDING PERMIT ISSUED----------------- ------ - ----- ----- .......:--- .111--------------------- Alteraflons and/or recommendations:-.------- -------- �4-a- I -Z.O.V-4,------------- ---------------------------------------I------------------ -- -------------- ------------------------------- -------------- -------------- --------------- ---------------__1-------------------------------------------------- ------------------------- -0------------------------------------------------------------------- --- ------------ ------------------------------- --------------------------------------------_------------------------ -- ----- -------- - ------------------------------------------------------------------------------------------------------------ ----------------------------------------------- ------------I---------- -- - -------------- --------------I------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY: ----------------------------------- --------------- Date-------------------- --------------- SAN ate------------------------- -----------SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 914 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California