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APPLICATION FOR SANITATION PERMIT Permit No. A,71-4.7 ,-w/ �. (Complete in Duplicate) z ] S s Date Issued Applica+ion 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 549. JOB ADDRESS,AND L ON.... -0-- - ------- -- ----------- •-- ------------- ----------------------------- - Owner's Name ----- -- -- - • -- ------------------------------ ------------------------------ Phone .�� Address- '/'1- --- - -------- ------- - Contractor's Name--------------- ----------- 1 -------------------------------------------------------------••------ ---------------- Phone _ Installation will serve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- -- Number of bedrooms .I---- Number of baths I--__ Lot size __41 ��-------------------------- Water Supply: Public system Community system ❑ Private ❑' Depth to Water Table"-Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob�Hardpan ❑ Previous Application Made: Yes ❑ Not New Construction: Yes /� ►� No ElTYPE 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, -Distaer from,foundgtion-- M fe I_.- ----------Liquid dep�h - WCaacitgdevNo. of com artments__ ��—.._._ Size_ _ � Disposal Field: Distance from nearest we€I-_------- ....Distance from foundation--------------------Distance to nearest lot line--_-----.---...._ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------.---------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------- d Seepa e Pit: Distance to nearest wellDi____Distance f om fo dation_f-�-._f__-_.Distance to nearest lot line ... Number of pits---/----------------Lining material.• , ._ ---.Size: Diameter----Y--------------.Depth----------- -_----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_-.-----.-----------_---- _-__--_--. ❑ Size: Diameter------ -------------------------------Depth----------------------:-----------------------------Liquid Capacity-.--------------------------gals. Privy: Distance from nearest well-------------------------------------------------- from nearest building----------_-_-_-----__---___----_____-_. [� Distance to nearest lot line------ --------------------------------/------- _-1--_-_--_-"_�-------- --•----------------------------------------------:------------------- Remodeling ------- _.Remodeling and/or repairing �"��. �'=_nom_ ____________ V --- --------• -•---------------•--•---------------- ---- ------------------------------------------------------------------- --------------------------------Y------------------•-----•--------------•-----•---------------------�-•----------------------•--••------•-•-•----------------------------•---•--••--•--------------------------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and4les and regulations of the San Joaquin local Health District. (Signed)-------- ------ _ ---f- -_-------------------- - V wner and/or Contractor) By_____________________'__r--!/___1--)w-_..------_.__.--_-___--____-_--------_._---__-_------------_-----___--.--..-_-__-_-(Title)-----__. . ___.__-.__._._..__-.___.___.... (Plot plan, showing sire of lot, location of system in relation to wells, buildings, etc., can be plac�d on r arse side). �. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------------------------------------� --------------------------------------- DATE------------- `c7----------------- REVIEWEDBY---------------------------------------------------------------------------- ------------ ---•---------------------------- DATE---------------------- ------------------------------ BUILDING PERMIT ISSUED--------------------------------------- ------ -----------------------------------• DATE-------------------------------------------- ---------------- Alterations and/or recommendations:------------------__--t-----__.__________._ ..-......_.------------ _ �-------------�:--------- --------�---- ----------------------------------------- -------------------------------- ---------- ---------------------------- - FINAL INSPECTION BY:..------------------V4------ Date �1 -----�-`�---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California E5-9-2M ; Revised W-2100