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N ��Permit No. �1�� APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) .4 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 No. 549. �1 JOBADDRESS AND L CATION =-----------9--•--- ----------------------•-•------------- -------------•----....-----------------�----------------- Owner's Name--------.�._.__...__ --•--•------------- -------------------------------------------------------I---------- PhoneG r:.'� /f Address-------9-`6'�- ----/_/a.:------ .,-Vs------- ------------•---•-•----•------------------------------------••---------- Contractor's Name------ 'r s`�. ------ --------------------------- Phone-. 4!< G� Installation will serve: Residence ❑f Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/--- Number of bedrooms_'-1--. Number of baths .1.._ Lot size ------------- .-.S------------------------------ Water h__-..____-__............... Water Supply: Public system W/C:ommunity system ❑ Private ❑ Depth to Water Table? `? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EZ--Hardpan ❑ Previous Application Made:- Yes ❑ No [] New Construction: Yes ©--<o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic n p : Distance from nearest well------------------Distance from foundation--------------------Material ................_..------------.---------------- D No. of compartments------- ------------- ----Size--------------------------------Liquid depth----- Capacity----------------------- Disposal Field: Distance from nearest well---,-------------Distance from foundation....................Distance to nearest lot line_......_...___.. ❑ l J1�1ff�""•Number of lines-----------------------------------Length of each line---------------------..----.-.Width of trench----------------------------------- [JlcJT7�� Type of filter material-------------------------Depth of filter material-------------...-------Total length------------------------------------------ _ f �r Seepage Pit: Distance to nearest well---/:6.!Y1 -Distance from foundation_.i -------LDistance to nearest lot line__:1------- ri .... Number of pits------ -----------Lining mateal �G ....Size: Diameter-- j-----------.--- Depth.----- ----------------!----- Cesspool: Distance from nearest.well-----------------Distance from foundation___-----------------Lining material-----.---------1../...........---- �] ❑ Size: Diameter-----------`--- ---- -- .Depth - R --------------Liquid Capacity----------------------------gals . `w Privy: Distance from nearest well-------.-----------_....._--------..._-_-_.__..Distance from nearest building------------------------._..---......-.... ❑ Distance to nearest lot line---------------- ----------------------------- ------------•-•-------- ------------- ------------------------------------------------------- 4Cit? Remodeling and/or repairing (describe):.--...... -------------._-! L ---------•--•-------------•---------------------------------- -------- ------------------------------ ------------- -------------------------------- ------------------------------------- -•-••----------------------•--.------------------------------------------------------------ ------•---------••--•--------•---------- r --------- ------------------------------------------------------•------ ------------------------------------- --------- ----- ------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, yStaff laws, and rules and regulations of the San Joaquin Local Health District. Si ned �A r/ ��- -�'- ---- - --( ner and/or Contractor) ( 9 )------ u� - r ----------------------(Title)------- (Plot pian, 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_- REVIEWEDBY---------------------------- .:------- -- --------------:------ ---- ------------------------------------ DATE---- --------------------------------------- -------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------ DATE.- ---- tA----------------------------------------------- Alterafions and/or recorpmendations:--------4---------- ------------- i------t--------------- •---------- I'--- A# 4------ Air ---------------- ----------............!r_._..._.-.-..........._.-.....-._..__......-------"--............-.__.........._........._.-._................--............_................_...__._..._.__.....................__.-.__..-.._.._.... qr -------------------------- -----------------�� .. °-��r- ..�. �. FINAL INSPECTION BY---------------------- ------------------------------------------ Date. J --- ------------------------------------------ ...... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 Soufh American Street 300 West Oak Street 132 Sycamore Sfreet 814 North "C'Street Stockton, California Lodi, California Manteca, California Tracy, California ES--9-2M 145446 ATWOO6 12-54