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APPLICATION FOR SANITATION PERMIT 'Permif No 5.0__7_----- �" [Complete it Duplicate] o ►/ Y J Date Issued Application 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. JOB ADDRESS AND LO AT ON---____-- -- ��✓/_� % '--_------------------- ----------------------------------------------------------------- .--. s�- Owners Name----- Phone ------ ------------------------------------------------- ---------------------------------- Address----------='---------- ------ ----=� " Contractor's Name____-I___/ -4 -• �� Phone—, G ------ Installation -- a -�c Installation will serve: Residence L] Apartment Hous� Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ f Number of living units: ______ Number of bedrooms _ _ Number of baths �------ Lot size ______l!_ _ _ _ Water Supply: Public system. ❑ Community system"[] Private ❑ Depth to:Water Table Character of soil to a dept1�;,f 3 feet. ' SaW ❑ Gravel ❑ Sandy Loam ❑Xlay Loam ❑ Clay,E] Adbbe ef�Hardpan ❑ Previous`Application Made Yes ❑ No [6 New Construction: Yes d No ❑ t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`br cesspool permitted if public sewer is available within 200 feet.) V Septic Tank: , ,Distance from nearest well_______________I Distance from foundation___________-_______-Material___________--_-----_________________,__________.,, i �ti ❑ .C•a �N l of,co k partments---]--------------------- ize----------------------------------•------Liquid dept.h--------------------------Capacity----------------------- -`/ _ �`= ` Disposal Field: - Distance frominearest welX__•��'�_ Distance from foundation___!_____:____Distance to nearest lot line__ )✓__ r r - a' � Q / . Number of lines__ __ --� -Length of each line___ r1_______________ Width of trench_-_�_____-_-- ---___________ s C y .- Type of filter material--��r, 4d'_De th of filter mater ia ---- length TYP - p g ; i - Seepage it: Dis�ance to nearest �i '__.._Distance Qrn fou `ation__f_ ___±___.Dis#�ce to nearest lot line_ s f & "`'` Linin materially_ ? y Z /Number its_ Wt-Size: Diameter-_K___ ___ 44 -/1f'� �- „�- -- - - -----------.Depth---- �----------- of -------- Ces pool: Distance from nearest well---_-------------Distance from foundation--------------- material--------.__-____--.--_:______..___._ ❑ Siz& Diameter--------------------------------------Depth------------------------------------------------ .---Liquid Capacity--------------------- -----gals. Privy: Distance from nearest well-----------------------_______-----_____---r__'Distar,ce from nearest building_--________________.____________________. ❑ Distance to nearest lot line________ ��,� y --r A -"� Remodeling and/or repairing (describe)----------=�-------- ��-- --- �, - -:-t�.�--�------•-----------••-----------•------------ ` I � ' ---------------------------------- --•-------•------------------------------------- ; ------------- •------------------------------ 1 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,„an ules regula ions of the.San Joaquin Local Health District. # --I (Signed)_________ (Owne and/or Contractor] I -- --- -------------- � -;; By: -- j ------------------------------ --------- ------------------------------- f (Title] f (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). k I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--'? DATE �' i REVIEWED BY -- ------------ DATE----- ----------------------------------------- =- BUILDING PERMIT ISSUED----------��-------------------------------------- -------------------------------------- DATE-------tA Alterations and/or recommendations:-----------------------------------------------------------------------------------•------------------- - �-- - -----------------•----------------------------------------------------------------- -- ---------------- ---------------------------------------------------------------------------------------- 14� FINAL INSPECTION BY:----- rt/_ Date---- - -/-Q_ z------------------------------------- ------ I 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 8-51 Revised W-2100