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APPLICATION FOR SANITATION PERMIT Permit No. 3�c/-"__.3.__._ 0Ap/)*,�i/cati,,n'i,s (Complete in Duplicate) DateIssuedVhereby 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 No. 549. JOB ADDRESS AND LOCATION-------I----1-6-2-F----GU-'------�� t7 L P'��----- �--r�------------- ----------------------------------- --------- /-/, � U 5 Phone Owner s Name---------------------------------- ---------------------------------------- -------------------- ----- -- - Address_------------------ -- �'�------- a=�`-- --------------------------- •- _-----------------------• -•------------ Contractor's Name----------•-••-------------••------ . �Ys� -- �av- —1111 lCc `u---------•------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: ________ Number of bedrooms --------- Number of baths -------- Lot size ------------------------•--._________-____________________ 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 ❑ No ❑ New Construction: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation-------.------------Material---------------.--------------------------------- No. of cosrpartments_____________ ------------Size___:---------------------------Liquid depth---------- ---- - --------Capacity----------------------- _ Disposal Field: Distance from nearest well----____---------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___._-__--..-___________________-_______._ Seepage Pit: Distance to nearest well---------------------- from foundation-------------------.Distance to nearest lot line_____.____._____ E ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_--------------------.Depth--------------------------------- Cesspool: ---- ------ Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material------------------------- -- ____ ❑ Size: Diameter--- ----------------------------------Depth----------------------------------------------------Liquid Capacity--- -------------------gals. Privy: Distance from inearest well-------------------------------------------------Distance from nearest building_______.________-.--_-_--_____.._____-___. ❑ Distance to nearest lot line-------------------------------------------- ---------------------------------------------------------------------•--- ------------------- Remodeling and/or repairing (describe]: W-f � i- 4 f I----------------------- -------- --- ran -r------- '---------------- ----•------------------------------------------- ---- --- -------•--------------------•--- C - --9=nj= `�°"�$---- 0n `=l -t_�c.' �' s�d�s------ginLc�. 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. 1 . 4 (Signed) R -•----------- ------------ (Owner and/or Contractor) 4-4 By:. ------••--------------------------------------------------------------------------------------------(Title)-------------------------------------------- ------------------- (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 APPLICATION ACCEPTED BY-------------------- --------------- -------------------------------------------- DATE---------- ----------- REVIEWED BY ---- ----- DATE----------�-_ '-•�.�--- ---- BUILDINGPERMIT ISSUED----------------------------------- -----------------------•------------•---------- ------------------- DATE.----------------------------------- -------------------- Alterations and/or recommendations:------- -------------------- -------P.0 ------------------------------•---•----------- -------------------------------------------------•--•----------------------------------------------------- ------------------------------------------------------------- ;,; .�- ----------- ------ - - - 4 ,r` f" - -�------------------------- -------------------- -- ------ --------------------------------------------------- - --------------------------------------=----- ------------ v,,�'� � FINAL INSPECTION BY--------------------------------------------- Date ---------------•-- -------- 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 ES--9-2M Io-52 Revised W-2100