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T. - -- 3 APPLICATION FOR SANITATION PERMIT � Permit No. . --- (Complete in Duplicate) 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 N�o. 549. a[.,.>F • sV D _TV 0�O2Q j 1/ !____- ±Gr_�_..,4_rYr-Qf`r31/ 'r! 1F-----�------ JOB ADDRESS AND t�4 - Owner's Name---------------�^� C-`--- ` �� ^ "`� Phone. Address---------------------------- •- ------------- Contractor's Name------------------------------- -- -------- ------------------ Phone Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court.❑ Motel ❑ Other ❑ Number of living units: ---1--- Number of bedrooms _4_. Number of baths ---1--- Lot size _A—___A-------------------_-_____________----_. Water Supply: Public system ❑ Community system ❑ Private 5T' Depth to Water Table7__'O. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam RT Clay Loam ❑ Ciay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ No [ New Construction: Yes ©"e No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: CJS No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: .p Distance from nearest well__�0__-__..__Distance from founda iion__.!a_____________Material__�___g7�'-----------._.____ ----------- "I ____._ _.- p 1" ®� No. of compartments--------0�--------.- --Size----- depth----,� -----------------Capacity__- a -r Disposal Field: Distance from nearest well__�U..l...!'_._Distance from founclation__>'>_----------Distance to nearest lot Iine.lS__--_____- �1 Number of lines------------3- - ---------------Length of each line!Sr.�`�3'��.--.Width of trench.__syh------------------------ Type OT filter material--- _:. t__ '.-Depth of filter .__.Total length ___________________________ b Seepage Pit: Distance to nearest well_---------------------Distance from foundation--------------------Distance to nearest lot line------------._-__ 1 ❑ Number of pits----------- ----------Lining material-----------------------Size: Diameter.---------------------.Depth----- --------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation---_----------------Lining material--------------- Size: Diameter----------- -- ----------------- --- Depth---------------------------------------------------Liquid Capacity-- -------------------------gals. RO Privy: Distance from nearest well--------------_-------------------.----------- __Distance from nearest building._____.._____._____.____.---____.____._._. ❑ Distance to nearest lot line-------- ------------------------------------------------------------------------------------------------------------------------------ Remodelingand/or repairing (describe)---------------------- ---------------- -----------••----------...-------------------------------------------------------•-------------------•------------ - ------- --•--------------- -----------------------•------------•---------------------------------------------------------------------•-_._....----------------------------------------------------------- ------ - -------•----------------------------------•-------•-•------------•--------------------------------------------- ----------------------- ---- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ;F ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned F�)_ 0 1..)�t,r�(a --- ---------- ------------------------------------ ---------------------------------{Ow r and/or tor) (Owner Contractor) By----------------------•---- Tale ------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR pEPeARTMENT U5E OILY APPLICATION ACCEPTED BY- _ I ___C 1 _�� 1 --- �-- DATE---7Z//>--------------------------------------- r �'?c REVIEWED BY----------------------------------------------- V ------ DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------•------------------------_------------• DATE. Alterations and/or recommendations: .----------- ------------------ -------------------•--------------------------------------•----------------------•--•----•.---------------....--------•- ------------•-------------------------------------------------------------------------------------------------------••------------------•-----------•-- ---------- ------------------- --------------------------------------I----------- ------------- -------------------------------------•------------- FINAL INSPECTION BY:------- -------------• Date----- --------------- ------ V SAN JOAQUIN LOCAL HEALTH DISTRICT 134 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California ' Lodi, California Manteca, California Tracy, California ES-9-21VI 145446 ATW000 12-34