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JL APPLICATION FOR SANITATION PERMIT Permit No. . ! (Complete in Duplicate 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. 544. JOB ADDRESS AND LOCATION.. Q ----------- Owner's Name.-- - 4 ; - = Pone ll Address------------------ = r . . .._. . - -------------------------`-�- -------- Contractor's Name -••-•------- ------- ---. Ph _ - i S Installation will serve: Residence Apartment Hous" bmm rcial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __J<____ Number of bedrooms / G " --- Number of baths --t---- Lot size ---------- ----- ---- �'-- --------------------- ---- Water Supply: Public system [:1 Community system[-] Private Depth to Water Table%L_a ft. Character of soil to a depth of 3 feet: Sand 171. Gtavei E] Sandy Loam [Clay.Loam El Clay E] Adobe C1 Hardpan ❑ Previous Application Made: Yes ElNo4 New Construction: Yes R"'No ❑ TYPE.OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T-4 ank: Distance from nearest well-----------------Distance from foundation___________________Material---------------------____._______.___________-. E No. of compartments--------------------------Size-_ ----- _ Liquid depth---------.----------------Capacity----------------------- Disposal ---------------Dis osal Field: Distance from nearest well-__ S�....Distance from foundation___._ __ --.-. la),_. Distance to nearest lot line.....--- ..... I Number of lines---------._,--- ----- Length of each line--------- —------Width of french--------- Type of filter material ___Depth of filter material____1-__..____Total length_____________�.__.___dI------------- Seepage Pit: Distance to nearest well -------Distance fro,,��,.,,efoundation_�l� �-1L_ Dis_mace to nearest lot line__________.._.____ [ Number of pits__ __ Lining matefial___' Sixe: Di eter___-. _ Deptn-------�4-_____________________ i "Cess❑ool: Distance from nearest well_________________Distance from foundation.,r________._.____lining material-------------------------------------- El _.___ _--____.______________________- { I? W Size: Diameter-----------------------------------------De th---------------------------------------------------Liquid Capacity-------------- -------gals. Privy: Distance from nearest well ______------------------------------------------Distance from nearest building-----------------------..____________..._. ❑ " Distance to nearest lot line--- ------------------------ - ---------------- -•----•---••-------------------------------•----------- Remodelin and/or re airin (describe): ______ ' � vF`� '�� ---- --•- U 1." 9 p I r---= -------- -- i •--------•-••---------------------_----------------- -----•----------- --------------•-----------------------------------•------------------------------------ ---------------- J----------- ----------------------- --------- -----------------------------------------•------------•-•-----•---•-•---•---•---------------•---•---.----•--------------------------------------------•-•---------------•--------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinan a laws, and rules and regulations of the San Joaquin Local Health District. _ (Sign d ............ '`"y`s, y---------------------------------------- ------------ ---- ---------------•-----•---------------t...........(Owner and/or Contractor— ----- -----�'--" _%.:A-----------------------------------------------------------------._._(Title)------ ��=-------- ----- - - ------- (Plot plan, showing size f lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMRNT.USE ONLY APPLICATION ACCEPTED BY---- DATE----------•------" -- REVIEWED BY ...... -----?_ISSUED------------------ ` ---------------------• ------ DATE--------- -------------------------------------- Alterations -----------------------------------Alterations and/or recommendations-------- --------- -- ........ ----------------------••--------------------------------------------- -----------------------------------------------------------•---------- ------ ---------------------------------...----•------------------------------------------- .....--------------------------•--•---------------------- ----------------------------------•--------------------=------ ------------- ------------------------------------------------- ---------------------------------------------------- -----••------- ---------------------------------------------•------------- FINAL INSPECTION BY:----- -----. - Date ---- -� � _/_7----------------- 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, Califoinia i 3 E5--9 145446 ATW00D f