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APPLICATION FOR SANITATION PERMIT Permit No. 4 (Complete in Duplicate) 1!l I Date Issued Applica+ion is hereby made to the San Joaquin Local Health District for a permit r construct and install the work herein described. This applic-a}ion is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC TION__'c!:ZC C-C .---�----- - '--------------------------------- -- -- - - - ----------------- - Owner's Name'----- �-------------- ------- ----- ------ Phone Address '-`-=-SC ------ Contractor's Name------1� �`� /---f-- --------- ----- --------_- -------•--.---- Phone-------.--------•_-_._-----. ----- - ------------------------------------------------ - Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 4_:__ Number of bedrooms .!-.- Number of baths 1-_ Lot size .__ _Ll____., ___.L �---__ Water Supply:' Public system-❑ Community system ❑ Private ❑ Depth to Water Table ---------ft. Character of'soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam❑ Clay.Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Yes ❑ P No ❑ New Construction: Yes C] No ❑ TYPE OF ,INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.} �I Septic lank: Distance from nearest well_�la'��Distance from foundation--._1Q_.---_.-.Mat iaL___-__ :.__.___. ._' ----- No. of compartments...... -----------_____Size__ _ _ __'�_r_,--._..Li uid de th___ __. 1 q p. --------Capacity .S - Disposal Field: Distance from nearest well....C1_Cstance fromfoundation--_LQ..........Distance to nearest 1pt line-�--._ Number of lines-------�:....... ...... ngth of each line----L__..Q__.-jFj .Width of trench. __ ._._.-----_-_--_y ---- - Type of filter material.- �._ filter material____.1 __..______._Total length---l__ ________________________________ Seepage Pit: Distance to nearest well.------------ --------Distance from foundation--------------------Distance to nearest lot line--.--.-_- ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.----------------------Depth--------------------------....... Cesspool: Distance from nearest well-----------------Distance from foundation............. ......Lining material___.__-.-_-----..-.----___.--_--_._. ❑ Size: Diameter_---- ------ ---_--------------Dept h---------------------------------_----------------Liquid Capacity- --------------------- Privy: -------------------Privy: Distance from nearest well-----___-----------------------------------------Distance from nearest building____--____.__.______f____..____-________- \' Distance fo nearest lot Iine--------------------------------- 4. Remodelingand/or repairing (describe):--------------------------------------f:------------------------------------------------------------------------------------------•---------------••----•---•-•-•-----•---•----••-------------------------------------------------------------------------------------------------------------•-------------------------••- -----------------••---- -------••----------------------------=------------------------------------------------------------------------------------------------------------ ---------------------------••----------- - ---------------------• ----•-------- ----=------------------------------------•--------------------------------------------------•------------------------------------------------•----------------------------------- 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. 5i ned I ---------------------------------Owner and/or Contra or By:------------------------------------------- = [Title)------------------------------------------- - ------------ (Plot =(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 APPLICATIONACCEPTED BY..----- 3------------------------ --------- --------------------------•---------------- DATE--------1-----------...-------------------------------- REVIEWED BY------ ------------------------ -- - ----------------------------------------------------------------- DATE----------------- ----------------------- BUILDING PERMIT ISSUED--------------------------------------- ---------- ••----------- ----------- DATE----------------------- Alterations and/or recommendations:--_-_ --------- -------------- --------------------- --- --------------------------------- •-------- - --- - f l y I 11,,M ... . . . -------- -- --- , Yl__ 3! r �t-` r'� �}' --,---n---1-- = f�21�Z.2 - � f FINAL INSPECTION BY:- --I_l- --- --• -- ------ Date- _ ---�-�- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT r 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES---9 ia5aas,n7 wppo