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APPLICATION FOR SANITATION PERMIT Permit No. ... .f_ .r------ (Complete in Duplicate) Date Issued _-11161- A L 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. ` • g 1 t = ---�----1-,----- -- ------------------------------------- JOB �' � � J ) ADDRESS AND LOCATION-----------------------�------------�iY" - PhoneS� * _ -...Owner's - 4 f Add ress----------- `�-_4-- �` �.r__ o w,� Y-' f. -.6 -- --------------------------------------- -------------- --------------------------------------------------------- Y " Phone Contractor's Name-_.--�lN - r- on ----•------------------------------ Installation will serve: Residence I& Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - i Number of living units: J----- Number of bedrooms ..2__ Number of baths -1----- Lot size -- .�-_."".-_ -_-� _ _..---___"----_- ---------- Water Supply: Publictsystem V Community system ❑ Private ❑ Depth to Water Table «:__._. ft. Character of soil to a depth of 3 feet: Sand E] Gravel F1 Sandy Loam El Clay Loam El Clay ❑ Adobe Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes No ❑ TYPE}OF INSTALLATION AND SPECIFICATIONS: I•�Ij �� ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e .,. .' A 4 1 0 --------.Meferial_ Septic Tank: � Distance from nearest well_�a/��,";Distance from foundation_. _" .�L - ---- No. of compartments....;D-----------------Size._�_x-�__X_q-- ---Liquid depth-----.-----------------;Capaci#y-__ 4-a_--_----- s. Dis al Field: Distance from nearest, well�4 n/e_-Distance from foundation-;__1-d-_:-_---.Distance to nearest lot line,__b ---- Number of lines---------- -• ------Length of each line____-_>!a-�]------/------.Width of trench.-f>�__------------------ Type or filter material�r _G_- of filter maternal___,9-_-_.._:-----Total length..-_---_�-_ 0__.___"__._-___"---. v �- - '� Seepage Pit: Distance to nearest well_--._�-."_---.�.__"--=Distance from ---------------Distanceto nearest lot line---.""_----____"- F ❑ Depth--------------------------------- Ej of pits----------------------Lining material-----------------------Size: Diameter-.------------------- - - y Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__..___.._""--_____"----____-__---__. ❑ Size: Diameter--------------------- '_ -Depth""--------------------------------------------------Liquid Capacity---- - -- --------- near -- --• •9a1 i DistaneeYfromrnearest=weir, -_-_- Distance from nearest building ------_---" ---------------------------- � . G y. .r m ❑ Distance to nearest.'lot1line----'-----------------------------�" � " f Remodeling and/or repairing (describe):'__.'<__.� .-.------------:------------------------------------------------------------------------------------------------ ---------------------- -------------••---------- ------------------- •----------------------------------•------------------------------------------------ � i ; _.__.. - l - ----------------------------------------------------------------------------------------------- ------------ ------------------------------------------------------------------- i s I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County and rules and regulations of fhe.San,Joaquin Local Health District. ordinances, S+ate"laws; ` __---Owner and/or Contractor) (Signed)--------- - --------------------------- By=-------------------------------------------------- - ----- --------------------------------------- s ----- -------•-----------------------(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.------- ------------------------------------------ -- ------------------------------------------------------------------------ __ DATE-------------------- ----- REVIEWED BY------------------ -- --------- -- -. J� B€JILDING PERMIT ISSUED = .... DATE. �------------ - = ---------- Alterations and/or recammenda+ions: = ------_ _ ---•-•--------------•-----------------------------------_--. -------- --------�-�� ---------- --------- ` ------ ---- - ----------------- - -------------------------- ---------------------------------------- - - - i FINAL -INSPECTION-BY:'-'!.-1__'_ - .. . �-- Date- / - 5 ``------------------------••------ -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 f. rS-9--2M Revise W-2100