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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued . . . _ _ .. Applca4ion is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Th's application is made in compliance with County Ordinance No. 549. s r� ` 'f JOB ADDRESS AND LO�ATfON------ == LIG-------A14---------��1-�� -�-� � k -----------------•-• --------------------------------------- Owner's Name c -•- t "` ------......... --- -----: Phone--------------------------------_- ------------- Address ----------------••--------.._. ------ _ may. j .. .. ... -. . .- - Address------------- h�-l�'----•---7-�' -�-•-•---- - --- �-- --�-'---�----�•-----------------------------=--•_•_.-------------•----.._....--•-------------------------------.. Contractor's Name__.�f�' -----T -----5e-6V------------------•----------------------------------- Phone./l/v---k?LW-1 Installation will serve: Residence )Apartment House ❑ Commercial ❑- Trailer Court [3 Motel ❑ Other ❑ Number of living units: 1/___ Number of bedrooms .It-- Number of baths __1-__ Lot size ------- -_ C_� --------------- -Community system F1Private E] Depth to'Water Table eft.' Water Supply:' Public¢systemlo Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe. Hardpan ❑ Previous Application Made: Yes E❑ No W, New Construction: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i 1 {No septicor cesspool tank} permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL__/� -Distance from foun>datiora��..._._______.Ma/ter�a`�____-_______________ _________��______. No. of co:partments------- -----_-----+Size__ +�.�_..r 12k----Liquid depth----__/0C,o--A_ Capacity---- -----------,- Disposal Field: Distance from nearest well___/)/ Distance from foundation__�-./�-________._.Distance to nearest lot line.,._. ..... Number ofOnes----------- f__;{-----__._,}:Length of each line_._______ /P!-__ -----Width of trench___ `-�` Type of filter material___� _____C�'_ ,Depth of filter material_______ _ _. .....Total length______��d�________________.__ x,,X_-Distance from foundation____________________Distant 'to nearest lot Seepage Pit: Distance to nearest well____ � ,� '' De th Number of pits ----------- __Lining materval... r_ l fi46xe. Diameter___ p Cesspool: Distance from' nearest well___,______t:_____Distance from foundation=-------------------Lining' material__.___________.______.______________ s . ❑ Size: Diameter-------.---. ---------- --- -=--.Depth---------------------------------------------------Liquid Capacity,..-------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building--------------------------------- ❑ "` Distance to nearest lot line------------------- ." ------------------ !� i Remodelingand/or repairing"{describe):-------'----------- -------=---------------------------•••-------------------- ----------------------------------=------•------------------•------------- I ------------------------------------- I....-- '---•-••-----•----------------------------......--------------•-----------------------=-----------•----------------•--•----•------------------------------- ---•-•---_+ ---------k--------------------------------------------------•----` •• ----------------- -----------------------•------------------------------------------•----- `_...--------•-•-•----------------------------------- r. I hereby certify that I have prepared this application.and that the work will-be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. Si ned .. c•'� ''� - - (Owner and/or Contractor) BY --- ate (Title) (Plot plan, showing size of lot,01location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------: - .. = ------------- DATE--------�---.....---------------------------------------- Ih DATE------- .... REVIEWED BY------------------------------ --- --- BUILDING PERMIT ISSUED-___-!- ----------------- ----- --- ---- DATE------------------ -- _ Alterationsand/or recommendations------------------ ---- -- ------------------------------------------------------•-----------•--------•-•------=----•- ---• ----------------•--- 1 ---------------- •---•---•-------------------- - ----•------•---- ,J" !-------------- ------ = .---------- ---•-• ---------------------------------------------------- -------------•-•--- --------------1__:---------------------------------------------------------------------------------------------------------------------•---------------------•----------------•-••---------------...----------------------------------------- ------------'------------- -------------.. =---------------=------•-------------- ---------•-------•------------------------------------------•-------------------------------- FINAL INSPECTION BY:.-." 3 _ Date__- _ `------�� - ---------------------------- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 30D West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California 7ES-9--2m Revised W-21001