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APPLICATION FOR SANITATION PERMIT Permit No. ---�-�---��----3•�. (Complete in Duplicate) -�-�- to Issued Application is hereby m ade'to the San'Joaquin Local Health District for permit to const uct and install the work This application is made in compliance with County Ordinance No. 549. ; rk herein described. f rr JOB ADDRI=SS AND LOCAT ON- _ ' Owner's Name-_"_""_"- 1 � _ _' --- Address- l t _-_ - = -=--'---- -- Phone- /� .r� f ------------- Contractor's Name "f�" Phone- --- -- f i -- ----- ---------- ` Installation will serve: ' Residence 0Apartment House ❑` Commercial ❑ Trailer Court ❑ Nvotel� Other:[] Number of living units: __ -_ Number of bedrooms __Number of baths -� Lot size _ e� Water Supply: 'Public syster6" Commuriif s stem -----------------`---""""" Y Y ❑ Private ❑ Depth to Water Table "ft' -� Character of soil to adepth of�3 f et:F Sand ❑ Gravel ❑ Sandy Loam [] Clay.Loam oam ❑ Cla Previous Application Made: 'Yes' No.❑ New Construction: Yes No YI Adobe Hardpan ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ ❑ ❑ FANA: Yes ❑ No.❑ (No septic tank or.ce'sspool permitted if public sewer is available within'200 f ' Septic Tank: Distance from nearesfi well_ Distance from foundation,_ ] _ 10 001, sr „ -� - aterial No. of compartments_-_ ------__-_ Size - �,�r M } F q P. ----Ca acit Disposal Field: Distance from nearest wail__F "-- = P yt . { Distance from foundation-- - -----------Distance to near. st I'o�}-line._. '_ U t�1 Number of lines_ ---_---Length of each line"--_ _ - s r y��- 9 ® =------Width of trencrl Type or filter material_ lfr Dep+h of filter material ��_ { ----,Total length-____"" Seepage Pit: _ Distance to ne res+well__'-_ _ �- ��" '_Distance from foundation_ ! - ince to neares '.f trfirae-- -- ---- �[ #Sr Number of pi -_ fea4-_ _Lining material_ R_ / Size: 17iam I �'/ in `- � * ate Dep+h "r _ esspoo : Distance from(n arest well_________________Distance from founds+ion---_"---------------------Linin material------------------------ Depth ❑ Size: Diameterg -------------- --------Liquid Capacity- -- --- ----- --gals.+ ----- Privy: Distance4rom nearest well ----------------- -----------------------"__"Qis#ante from nearest buildin 9 ❑ Distance to nearest,lot'lineµ'._;___-."" --------------------- ----------------- --- - -- -- -- Remodeiin and/or repairing (describe): _ - - '" - ----------- ------- ---------- I = ----------- ------------ . - , I hereby certify that I have prepared this application andahat a work will be doCe'in actor anc an Joaquin County ordinances, Stat ws, and rules gulations of the San Joaquin Local Health District. ' d Si neI ( g ) ,------- --- ! ' 0- Pvc { + Owner and/or Contractor) By----------- ........ ---- =-- -- ---------- (Title)-- (Plot -- (Piot plan, showing size of lot, location of system in relation to wells, buildings, can be.piace on reverse side). F FOR DEPARTMENT USE ONLY j APPLICATION ACCEPTED BY- __ - -. oa ' -------- - DATES REVIEWED BY-----------<----- ------- ---'-- 1 = �- � --------- -----•-- ------------------ ' - DATE- _. , BUILDING PERMIT ISSUED --------------------=�--------------------------------------- -------------------------- DATE--- QrN t Alterations a or recommendations:------------------------- --- "f-� ----------------- --------•I- _ -- -- 7ne'N � 1 lrJ"ref �� 1 � epx- . `7"i" =Pfr------- ----------- -------- ---------- ---- ------•---------------- 1" -- -------------------- FINAL INSPECTION�BY:-__--- -- --- t f� ---"'Date ----------------•- OAQUIN 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 ES-4-2M Revisea 1.57 F,P,Co.