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APPLICATION - FOR SANITATION PERMIT Permit No. ."1"S."""`�"- - (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. !' application is made in ;compliance with County Ordinance No. 549�'� , -- This " �d � -------------�----- -----------------•-------------------------------- # ADDRESS A LOC ON. ------ ..:» Ph ' -"--�-------- - one. I � Owners Name--- -- -------- ---�---•-u---��-- -- ----•--------- -------------------- i s7r- -------------•--- Address...--- �'i� �" ......... ----•---- ----------- --------- �, -- ---------- ------------------------- ------------------ Phone. r: Contractors Name (� -- - --- ---------- ;s Installation will serve: Residence g---Apartment House ❑ Commercial ❑ Trai er Court ❑ Motel ❑ Other ❑ f---- Number of baths -.._---- Lot size _"/__ - -------------•----------------------- Number of living units: -I---- Number of bedrooms " Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -------- ft. .11; 1 Character of soil to adept of 3 feet: Sand F1Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe Hardpan E]Previous Application Made:: Yes Fl. No ❑ New Construction: Yes F] No El TYPE OF INSTALLATION AND SPECIFICATIONS: 17 (No septic tank or 'esspool permitted if public sewer is available within 200 fegtI Septic Ta k: Distance from nearest weir'" . Distanc from foun ation-------------------.M- trial---------- ---------- --- - /`� kLi uid de th_.." Capacity------ NO. """ L+ No. of. Size rp ------------- -- 1- I l , l � - Distance.to nearest lot liar�""".."""""_". Disposal Field: Distance from nearest well"-Ii2- --Distance from foundatio """" Number of lines------ --- ----- -- --- Length of each line----- Width of trench"-" ------------- i Depth of filter material----- - ---- ----Total length-___- ------ --- ------- r Type I� filter material- -- ` Seepa Pit: Distance to nearest well"._� __ -.-Distanc from foundation--"_''Q..-----.Diistancgto nearest lot,fi _�- � Numb of pits Lin ng material ......... - Size: Diameter '� De tn- Cesspool: Distance from nearest well-----------------Distance from foundation." Lining material""""______""___."".-_---_"""""-"""" ❑ Size: I�ameter-------------------- ..--.Depth------------------------------ ------------------Liquid Capaci y--- -- gals. ------------ Privy: - Distance 'from nearest vreli"""�!--- ---"- ---------------------Distance from nearest building-v_ _--------------- Privy- __--_----- Distarice-to nearest lot line.... - ---------• --------- - ----•--------------------••--------- ---------------------------------------------------------- Remo eling and,or repairing (describe) ` ---- F ---------- 11 w --- ►- -------------------- -------------------- ---------------------------------------- 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 regulations of the San Joaquin Local Health District. : . l ` -------...(Owner and/or Contractor) �•u•�`7" . --. - �� -- ---------- -------- -------- -Ij Title (Plot plan, showing size ofd lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �P FOR DEPARTMENT USE ONLY DATE----- - APPLICATION ACCEPTED BY------------------ --- - -- -- -----.--------------•---- -------- ----------------------- DATE - - REVIEWED BY �, BUILDING PERMIT ISSUED--------------------- - DATE Alt rations and/or r`:ecommendatians:__"_"_.:"..""" -------------------- --- 1 cSQ�"d�' [" "h -T - r... --- A----------------- ------------------•-----------------------------------------•---------==--•-------------------------------------- --------------------------------- ------------------------------- ---------- ------•---------•--- .. v � ----••--- " - FINAL INSPECTION BY:--"-- - --�''.-.---- --,-�------ - -- -- Dater -----•----- - ----------------------- j SAN JOAQUIN LOCAL HEALTH DISTRICT 132 S camore Street 814 North "C' Street 130 South American Street Y. eet 300 West Oak Street Y Tracy, California Stockton, California! Lodi, California Manteca, California �—] 145446 ATWOOa