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ti1�� APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date issued -'S I cal Health District for a permit #o construct and install t e work herein described. Applica�ion is hereby made to the San Joaquin Lo This application is made in compliance with County Ordina ce No. 549. IN. � t JOB ADDRESS AND LOC TION---------AC._ ------ -'...._ -- ------- ----------- - --- ---- - [ -------- Phone------------------- Owner's Name------------------ s .m. Address----------------- ='� Phone_ . -�- 3P. ----------------------------- - Contractor's Name.......... " _" ---- -------- --------- ------------------ Address - Installation will serve: Residence (�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i g �/ , . Number of baths ---d_._ Lot size ----- 0rU--"- --•�--- ----I------- Depth ----- �I Number of living unith: __._____ Number of bedrooms _ De th to Water Tableft. , I' Water Supply: Public system Community system ❑ Private ❑ p Character of soil to a depthk of 3 feet: Sand ❑ Gravel [I Sandy Loam El Clay Loam ❑ Clay ❑ Adobe lardpan ❑ Previous Application Made:; Yes ❑ No ❑ New Construction: Yes k'; o❑ TYPE OF INSTALLATION A ND SPECIFICATIONS: (No septic tank or cl sspool permitted if public sewer is available within 200 feet.) f .. . --� �1 Mat rs I_-- _- Septic T k: Distance from nearest well_''��._._____DistanceQ found ion____ _ _____ _. �� No. of compartments-- ---------Size----- Liquid dep�h '�+" CapacityQ l� t . �Q"___..__Distance to nearest lot I�e_________________ Disposal field: Distance from nearest wel!__74-74 ------.Distance fro foundation__-_� I ,_t Length of each line--- -, ------�-------Width of trench.---- ---r--------=--••----- Number of lines___.__ _ __ Type of filter materials_ -_-.-Length of filter material-__�.�._.._�__Total len th__,____ g 'I" ---------------------- -DepthIN } , p /- --- ----- Seepage Pit: Distance to nearest w� ell__/..r�__ --------Distance from,fo ndation_____.(,___..___._.Di ance�,to nearest lot line__.L n� i 'I ,,,, "pp"--±"-__Linin material" s-Size: DiaFneter__.. < _...__.De tn_.__ i�umber of pits__t o - g �`l Cesspool: Distance from nearest welL_______________Distance from foundation...--..._.__.._..--Lining material-------------------------------------- v) ElSize: Diameter----------- ------------- ---------- Depth-----------------------------------------------------Liquid Capacity.--------------------=------gals. Privy: Distance from nearest well __________------------------------ ___..Distance from nearest building----------------------------------- - ______. ❑ 'I - -,---------------------- ------ -------•___ -__•-______y�__-___�..y�1R Distance to nearest lot line---------------- - o re airm (describe):_ ----------------- ----"---... _ -- ----- '= Remodeling and/or p IM g ------ """ ------ ----------------------------------------------•--------- --------------------------- - ------------ - ------------- ------ - ------------------------------------ 11 -----------------------------•------------- ---------------------------------•--• .! ----------- -- - ------------------"_ `----------- � _I 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 gulations of the San Joaquin Local ealth District. 4.� ---- ---- -------( r,.and/ Con#racfior} , (Signed)----- � - g . +l - ----------------------- 0 )Title) - -- Plot plan, showing size of�l - - --------- (Plot I�lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY _ APPLICATION ACCEPTED BY--- -------------------------- -- DA ------- �..__..-------- --- •---------------------------- - -- ------------------------------ BUILDING PERMIT ISSUED DAT - - - -------------------------------•------------------ DATE--------- -------r.---- D --_-- - ------ - --- ---------------------------- Alterations and/or recorrm l�endations:------. ------. •---------- ------ ----•- ------------------------•----------- ------- -•-------------------------------------- IN: -------------•------------ . --- ------------------------------------------------ ----------------------------------------------- -•------- •----------- FINAL INSPECTION BY:_.__.._... _-... s------------•---------------- Date---------------- -------------------------------------------------------------•- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California ll Lodi, California Manteca, California Tracy, California may' rr-9-2M 145446 erw000 12-s4 � �I � -